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UNITED STATES OF AMERICA. 



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PRINCIPLES OF MEDICINE 



AS APPLIED TO 



DYNAMICAL THERAPEUTICS 



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HERBERT T. WEBSTER, M. D. 

PROFESSOR OF THE PRINCIPLES OF MEDICINE AND PATHOLOGY; FORMERLY PROFES- 
SOR OF THE THEORY AND PRACTICE OF MEDICINE IN THE CAL- 
IFORNIA MEDICAL COLLEGE, ETC., ETC. 



DESIGNED AS AN INTRODUCTION TO THE STUDY 
OF ECLECTIC MEDICINE 




PUBLISHED BY THE AUTHOR 

AT 855 Broadway, Oakland, California 

1891 






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Copyrighted, 1891, 
BY HERBERT T. WEBSTER. 






To the Memory of a Kind Father, 
JAMES HERVEY WEBSTER, 

WHO FILLED A WAYWARD SON WITH AN EARLY AMBITION 
TO BECOME A SUCCESSFUL PHYSICIAN, AND CONTRIB- 
UTED SUBSTANTIAL AID IN STUDENT DAYS, 
THIS VOLUME IS AFFECTIONATELY IN- 
SCRIBED BY THE AUTHOR. 



PREFA0E, 

Nearly two years ago I begun the preparation of a 
work which I designated as "Dynamical Therapeutics", 
and for which the present little volume was intended as 
an introductory declaration of principles. This portion 
however was hardly completed before I found myself in 
indifferent health, — partly the result of overwork, and 
partly a sequel to that fashionable disease of '90, La 
Grippe, and decided to spend the following summer 
abroad, that the benefits of rest and change might be had. 

Upon a perusal of the pages of the unfinished work on 
my return, it seemed to me that the introductory portion, 
though incomplete in fullness of detail, in many partic- 
ulars, really constitued the most rational principles of 
Eclectic Medicine that I had ever seen, and as the pages 
of this portion were stereotyped, and there must still 
remain twelve months or more before the department 
devoted to specific therapeutics could be completed, I 
decided to publish them in a separate volume ; for the 
importance of a text-book of this kind for our college 
had long urged itself upon me. 

The work as here offered must therefore necessarily 
be liable to considerable criticism. If it had been 
written for the purpose of separate publication, many 
details which have apparently been neglected would 
have been supplied, but which now have been relegated 
to the second part. But it is nevertheless believed 
that the subject has been sufficiently canvassed to war- 



6 PREFACE. 

rant the presentation of these pages in a separate vol- 
ume, as a work containing a rational scheme both for 
the study and application, of modern medicine. 

While not intended as a treatise on therapeutics 
proper, but rather as an introduction to the study of 
that department, many therapeutic hints have neces- 
sarily crept in, as illustrations, which must make it still 
more acceptable. To facilitate ready reference to these, 
pains have been taken to render the index tolerably full; 
the author believing that the practitioner will thus find in 
it a source of satisfaction outside the mere theoretical 
aspect of the work. However, a companion volume will 
be published in time, which will cover the materia med- 
ica, fully corresponding to the scheme here presented. 

As a literary production the work is surely faulty — 
the author does not need be told this. It is the result 
of erratic efforts made in moments snatched from a busy 
professional life, during which time a large practice was 
encroached upon by the responsibilities of the editorial 
management of the California Medical Journal, and the 
filling of one of the most important chairs in a college 
curriculum — Theory and Practice. Frequent repetition 
will be found — though as what has been written here 
has been for instruction and not for entertainment or 
display, this may be fairly considered a good fault. 

Grammatical and typographical errors may be en- 
countered. A number have been corrected in the 
plates but it is painfully evident that others remain. 
Should the profession, however, accord the work a lib- 
eral patronage, an effort will be made to improve upon 
this issue in later editions. 

H. T. W. 



PRJEGIPLES OF MEDISIEB. 



INTRODUCTION. 

Elementary forms of life consist of single cells, each 
made np of a mass of protoplasm, usually containing a 
nucleus. Simple as the structure is, these lowly organ- 
isms possess the power of selecting material for nourish- 
ment from the surrounding medium, of appropriating it 
to their needs, and of reproduction, while many of them 
are capable of active motion. In other words, simple 
cells are capable of exhibiting independent nutritive, 
formative, and other functional activities. 

Higher forms are also cellular. All living bodies re 
made up of cells and cell derivatives, but the more co, ■ 
plex organization demands a community of cells with 
reciprocal relationship, so arranged and endowed as to 
operate in unison, while each one carries out its special 
part in the general organization ; but throughout this ar- 
rangement, certain elementary properties persist, though 
somewhat modified by the controlling influence of ele- 
ments and functions absent in the simpler forms. In the 
mammalia, of which man constitutes the head, as well as 
in many lower forms, cell function is evidently more or 
less governed by the influence of the nervous and circu- 
latory systems, but notwithstanding this the endow- 
ments peculiar to independent cells still prevail, each one 



8 INTRODUCTION. 

possessing the faculties of selection and appropriation, 
independently of the others. 

It is upon these properties that the therapeutist largely 
relies for success in the administration of remedies for 
the cure of disease. If cells did not possess a selective 
property and remedies could not be made to influence 
special portions of the body, the scope of therapeutics 
would be very much narrowed. ''Specific Medication" 
would hardly have been written, homeopathy would have 
had but a feeble following, and the medicine of the past 
would have made but little progress. 

Physiology teaches the selective properties of certain 
cells in the most emphatic terms. The lacteal secretion, 
the saliva, the gastric juice, the pancreatic fluid, the bile, 
the succus entericus — all the secretions as well as some 
of the excretions, are separated from the blood by the 
action of cells, the selective faculty of each endowing 
it for its special function. 

Going further we find that the cells of every structure 
possess a physiological endowment distinguishing them 
by peculiar selective properties. The red blood corpus- 
cles contain the salts of potassium in excess, while the 
plasma in which they float contains an excess of sodium. 
The cells of osseous tissue contain a preponderance of 
calcium phosphate, due largely without doubt to their 
capacity of imbibing the salt from the circulating med- 
dium. In short, every tissue is distinctive on account 
of its selective properties, though formative force carries 
out processes which make the distinction more marked. 

Of the selective attraction of the structures of the 
human body for specific drugs, there are also numerous 
well proven examples which no one will deny. Digitalis 
possesses an established reputation for its influence upon 
the heart — a specific or selective influence. In other 
words, an affinity exists between the sphere of the cardiac 



INTRODUCTION. 9 

functions and this drug which is infallible in its manifes- 
tations if a preparation representing the qualities of the 
recent plant be employed. The reputation of cantharis 
as to its affinity for the genito-urinary system is too well 
known to require more than * mention. There is un- 
doubted affinity between the specific emetics and the 
nervous centers governing the peristaltic action of the 
stomach, between cathartics and the intestinal canal, be- 
tween diaphoretics and the sudiparous glands, or their 
controlling centers, between the salivary glands and 
sialagogues, and so on throughout the gamut of old 
classification. 

But we go further and assert that every organ and 
tissue of the body possesses drug affinities. It might 
be difficult to make this assertion good by furnishing the 
proof in all cases with present means of knowledge; in- 
deed the subject is yet in an embryo state, though nu- 
merous the instances which suggest it. Yital processes 
are often so complicated that it is impossible to know 
whether a drug influences the tissues of a part or a ner- 
vous center exercising control over it. Physiology must 
make further discovery before these problems can be 
explained; though we already possess enough clinical 
knowledge to enable us to make valuable use of the sug- 
gestions in this direction, and the line of study, if carried 
out must materially assist in - making the practice of 
medicine more pleasant and positive. 

When we are able to prescribe an agent for every part 
of the body with precision the subject will not then have 
been perfected. The functions of cells are various, and 
the character of the impressions of different drugs also 
varies. A remedy that will bring about favorable results 
in one case because of its affinity for a part, may fail in 
another, because different functions may be at fault, a 
differentiation beyond the ability of the most astute pre- 



10 INTRODUCTION. 

scriber to make, perhaps ; a differentiation beyond the in- 
telligence of everything except the subtle law of affinity. 
Evidently, then, even with the best knowledge we are 
likely to obtain, the treatment of disease will not be re- 
duced to a practice of certainties. More than one trial 
may be requisite in order to select the proper drug from 
a group having affinities somewhat in common. 

To illustrate, let us take the larynx and its drug af- 
finities as an example. The leading drugs influencing 
this part are aconite, arum triphyllum, lachesis, potas- 
sium bichromate, potassium hydrate, spongia and stillin- 
gia. Each of these possesses an affinity for the larynx, 
but this is manifested when administered in therapeutic 
doses, only under certain circumstances. Aconite asserts 
its influence when acute disease of inflammatory nature is 
present, probably an influence exerted through the vaso- 
motor center of the part, croup and subacute inflamma- 
tory states resulting from cold, being its principal field 
of usefulness. In chronic laryngitis where tissue change 
has progressed beyond the control of the circulation it 
would be useless to attempt to bring about a favorable 
change with this remedy. Here arum, if there is ulcer- 
ation, or potassium bichromate, if there is a hoarseness 
without ulceration, or potassium hydrate if there is ul- 
ceration with profuse catarrhal discharge, (muco-puru- 
lent,) or stillingia, if there is chronic inflammation with 
history of struma, will be applicable. 

But these indications may not be clearly pronounced. 
The classifications and indications of medical writers are 
convenient as landmarks or suggestion of remedies, but 
in practice we do not find these indications very clearly 
set forth in all cases. There might be an inflammatory 
condition pointing to aconite as the remedy which spon- 
gia would control more readily, and the reason for this 
be difficult of explanation. There might be an abnormal 



INTKODUCTION. ,. . , . 11 

. A A i /I I 1 1 

state of the larynx giving rise to hoarseness without 
evident structural change, which potassium bichromate 
might fail to benefit, but which would promptly yield to 
arum, or stillingia, or potassium hydrate, or arsenicum 
iodide, or nitrate of sanguinarina, or verbascum, and the 
reason be entirely unexplainable because there are certain 
peculiarities of affinity which are not yet known. 

Lachesis seems to influence the nervous centers of 
function and sensibility of the larynx in a pronounced 
manner, usually relieving cough of irritable character 
where the nervous element is predominant and there is 
little evidence of structural change, but sticta or nitrate 
of sanguinarina might fulfill this indication better, and it 
would puzzle the most astute observer to give the reason 
therefor. 

It cannot fail however to prove advantageous to pos- 
sess a wide knowledge of the drug affinities of every 
part. Such knowledge places us in the immediate neigh- 
borhood of means likely to cure, even though we must 
still- be liable to necessity of numerous trials before the 
proper remedy is discovered. Long practice, close ob- 
servation, or acuteness of intuition, may enable one phy- 
sician to excel another in the selection, but the most 
indifferent prescriber must be able to do better than 
one who has not given this subject study. 

There ought .to be agents to encourage the growth of 
every tissue and to promote the normal activity of every 
function of the body. Many of these it is true are yet to be 
discovered, though we have already learned to differentiate 
with respect to different remedies having affinity for the 
same organ. It was once enough to believe that all rem- 
edies were cholagogues which influenced the liver in any 
manner. Now we entertain somewhat different views. The 
secretion of bile depends upon the action of a special class 
of cells to influence which, when impairment of action is 



12 INTRODUCTION. 

present, we require a special class of agents, of which chi- 
onanthus may be taken as a type. But jaundice may be 
the result of impairment not directly due to faulty func- 
tion of the bile secreting cells, but due perhaps to faulty 
circulation in the hepatic blood-vessels and more amenable 
to such agents as cheledonium and nux, which probably 
influence the vaso-motor center. Or, the glycogenic func- 
tion may be disturbed, and glucose precipitated into the 
general circulation. Then we must resort to syzygium or 
nitrate of uranium, until a larger list of this class of agents 
has been unearthed. 

It is not improbable that with the liver, as well as with 
every other organ of ihe body, a better knowledge of the 
affinities of drugs for the tissues concerned in the func- 
tional activities in question, with increase of information 
respecting functions now little understood, will enable us 
to treat diseases heretofore considered incurable, success- 
fully. 

The general nutritive condition of an organ or part will 
demand special consideration, requiring in many instances 
a different class of remedies from those impressing its 
functions. However this need not invariably be the case, 
for structure and function are so intimately related that 
their therapeutics can hardly be completely separated. 
Schussler proposes to provide all the remedies required 
by a part, through the inorganic tissue-element predomi- 
nating in its structure, but we cannot thus simplify the 
treatment of disease, satisfactory though it would be. 
The inorganic elements of the tissues constitute valuable 
therapeutic reliances under some conditions, but they 
often fail when apparently prominently indicated. The 
explanation probably lies in this differentiation between 
structural and functional therapeutics. 

If new growths are ever brought under the controlling 
influence of drugs, it will be when a better knowledge of 



INTRODUCTION. 13 

their tissue affinities has been evolved. Grauvogl and 
others have asserted that cartilaginous tumors can be 
cured by the influence of silica, the effect undoubtedly 
depending upon the selective affinity of this agent for car- 
tilaginous tissue, and its tendency to correct abnormality 
of the nutritive processes of the part. Thuja has long 
been extolled as a remedy for the cure of warty growths of 
skin and mucous membrane, given internally, though it is 
quite likely that more failures than successes attend such 
medication. Even as pronouncedly sceptical therapeu- 
tists as those of the old school are asserting the efficacy 
of magnesium sulphate as an internal remedy for the cure 
of warts. 

Scattered throughout the literature of medicine, is much 
valuable knowledge of this kind which can be made more 
useful if given prominence through classification and other 
special notice. In another department, it is the purpose 
of the author to indicate some of the possibilities of this 
subject, and point out the principal information bearing 
upon it to be found in Eclectic medical literature, in such 
a manner as to adapt it to practical purposes. That all 
the propositions made in this Introduction will be fully 
enunciated, an emphatic disclaimer is here interpolated. 
It is the purpose to suggest more than can at present be 
demonstrated; for while this is the proper direction of 
study, for a fruitful field of therapeutics, much additional 
knowledge must be obtained before we can expect a frui- 
tion of all that seems promised. Some future author with 
more perfect physiological data, and larger accumulation 
of definite therapeutic knowledge, may carry this subject, 
thus imperfectly begun, to a better state of development. 

The subject of tissue affinity, cannot cover the entire 
field of medical practice. The fluids of the body are not 
tissues, yet they often demand remedial measures, in order 
to correct conditions involving serious derangement of the 



14 INTRODUCTION. 

entire economy. It would not be straining a point much 
to assert that in acute disease, our principal therapeutic 
reliance must be upon agents which either directly or 
indirectly influence the fluids, while in chronic disease, 
we must depend more upon remedies which specifically 
influence the tissues. 

Morphological elements of disease, — germs, promise to 
assume an important position in the field of pathology. 
Here we require an entirely different class of remedies. 
The disease in this case would really constitute an entity 
to be excluded or expelled, leaving aside the question of 
tissue integrity altogether. 

Electricity constitutes a means of reaching a part when 
required, independently of specific drugs. It really pos- 
sesses a tissue affinity of its own, — a general affinity, by 
virtue of the conducting properties of the tissues, which 
enable the physician to convey it to any part as desired, 
and thus produce a salutary molecular disturbance. Some- 
times this proves more efficacious than the most potent 
drug. 

Correct diagnosis, quality of. drug, size of dose, proper 
selection, and susceptibility of patient, are important ele- 
ments to be considered in connection with this subject. 
Neglect of these points will lead to failure every time; 
inattention to them has been the cause of much of the 
dissatisfaction and scepticism of the therapeutists of old. 

Ability in diagnosis will depend upon knowledge of 
physiology and capacity of determining character and ex- 
tent of deviation in disease. To the function impaired or 
perverted the proper remedy must be adapted through 
knowledge of its selective affinity, if a tissue be involved. 

Quality of drug agent is as important as proper selec- 
tion. Without doubt much of the difference of opinion 
among therapeutists depends upon want of uniformity in 
this direction. The average pharmacist is not conscien- 



INTRODUCTION. 15 

tious enough about the quality of his drugs, making it in- 
cumbent upon the careful practitioner, to be particular 
when purchasing or prescribing, that only those of known 
quality are accepted. 

Size of dose and susceptibility of patient sustain a di- 
rect relationship. Dr. H. C. Wood asserts that suscepti- 
bility of a system to the action of drugs depends upon 
the extent to which it is specialized in structure and func- 
tion. The cerebrum of man, for instance, is more highly 
developed than in the lower animals, and consequently 
more highly susceptible to the influence of medicines or 
toxic agents. The same author refers to the remarkable 
susceptibility of the frog, to the action of such agents as 
strychnia and opium, and draws an interesting compari- 
son between the effects of the latter drug in the two cases. 
Opium has a double affinity in all animals: one for the 
brain and one for the spinal cord. In man, with the large 
and active brain, the agent exerts its selective influence 
upon this part, and somnolence and stupor result; while 
in the case of the batrachian, with the relatively larger 
spinal cord, the affinity is more prominently manifested 
in convulsions, consequent upon disturbance of the spinal 
centers. 

In the human family we find almost as striking differ- 
ences. The markedly lymphatic person and the individ- 
ual of highly organized nervous temperament are almost 
as widely separated in their susceptibilities as the man 
and the frog. There is no doubt that the high attenua- 
tions of homeopathy sometimes effect cures, and that dis- 
ease is often aggravated through highly developed suscep- 
tibility, by ordinary doses. 

The effects of drug affinity are often modified by diet, 
climate, or other incidental influence, until remedial results 
are fully lost. The most approved skin remedies would 
fail to satisfy the expectations of the prescriber, if the 



16 INTRODUCTION. 

patient were subsisting largely on bacon or salt fish. In 
this case, also, the influence of a stimulating saline atmos- 
phere might play a modifying part. Vesical and renal 
affections could hardly be expected to improve under the 
best selected remedies if the patient were following the 
impulses of alcohol addiction or habitually drinking wa- 
ter highly impregnated with calcareous salts. Cardiac af- 
fections could not be expected to improve rapidly, while 
the patient was indulging freely in coffee, or tobacco, or in 
immoderate bodily or mental exertion, or sexual indul- 
gence. 

It should be remembered, also, that the reflexes often 
play "hide and seek" with the indiscriminating practi- 
tioner. Surely the fault lies at his own door if he fail to 
cure abdominal neurosis dependent upon anal fissure, rec- 
tal pockets, hemorrhoids, or stricture, with colocynth, di- 
oscorea, collinsonia, nux, cimicifuga, or other remedy that 
might seem demanded by the abdominal tissues. As rea- 
sonable would it seem to attempt the relief of cardiac ir- 
regularity hinging upon lacerated uterine cervix, chronic 
. endometritis, or other structural wrong of the reproductive 
apparatus, with Scutellaria, cereus, digitalis, or strophan- 
tus. True, temporary relief might follow as a result of 
the specific action upon irritated nervous centers, but no 
permanent effect could reasonably be expected. 

The intelligent physician will survey the whole field. 
He must do this in justice to the claims of therapeutics. 
No one but the charlatan will blindly prescribe without 
due inspection of all the premises. When rationalism be- 
comes the guide, instead of superstitious faith in mysteri- 
ous remedial action or blind following of a therapeutic law^ 
there will be more certainty in the practice of medicine. 



THERAPEUTIC CLASSIFICATION. 17 



THERAPEUTIC CLASSIFICATION. 

In the study of therapeutics, classification formerly con- 
stituted quite an imposing feature of the plan pursued. 
Writers were disposed to give more attention to the ar- 
rangement of the materia medica into groups suggestive 
of the general action and use of agents, than to the in- 
dividual study of each drug separate from its analogues. 
More modern writers, recognizing that much of the knowl- 
edge of the best virtues of remedies was thus overlooked, 
have discarded the plan of classification, and given the in- 
dividual study of each drug separate attention, ignoring 
the grouping of agents altogether. 

Individualization is, without any question, an excellent 
plan to pursue in therapeutical research. ' This is so be- 
cause every drug is peculiar to ^itself in one or more re- 
spects, and upon such peculiarity may depend its most 
sterling quality as a curative agent, while in the generaliza- 
tion of old methods of classification, this very quality was 
the one most liable to be overlooked. Still, a comparison 
with analogous remedies has been found advantageous fre- 
quently, in order to emphasize some peculiarity of the 
agent under study, and impress it more forcibly upon the 
mind of the student. 

But we cannot afford to discard the old classification 
altogether, for it includes some very essential resources 
which are often imperatively demanded. It comprehends, 
in the majority of cases, the physiological or pronounced 
drug effect of medicines, — an effect, apparent whether 
drugs are administered in health or in disease, so marked 
as to indicate disturbance of function as the result; yet 
such action is often desirable. 

However, our knowledge of the healing art can be facil- 
itated by the addition of a new classification, which will 



18 THERAPEUTIC CLASSIFICATION. 

recognize a finer effect of medicines, than that resulting 
from the old-fashioned, crude dose. 

The "dual action of drugs" of numerous writers, is a 
misconception. A drug invariably acts in one direction 
and in the same manner, except that in a large dose, 
through excess of action, it may become a disturber of 
function or structure to the extent of arrest or impairment, 
while in a sufficiently small quantity, it may produce the 
proper disturbance necessary to healthy rearrangement 
of molecular elements, and thus result in favorable change 
when disease is present. 

Upon the ground of dose, then, remedies should be di- 
vided into two general classes, the same remedy quite 
often appearing in both divisions, as its effects are modi- 
fied by amount administered. 

Take ipecac, for example, a drug which in certain doses 
disturbs the gastric functions violently, the disturbance 
resulting in nausea and powerful inverted action, — vomit- 
ing. Here we have no augmentation of function, but in- 
stead, an abnormal condition is for the time set up, — an 
artificial disease. In other words, the so-called physiolog- 
ical action of the drug is made manifest. 

How does a minute dose of the same agent affect the 
stomach? for it, as well as the larger dose, manifests a se- 
lective affinity for the gastric centers. Administered to a 
healthy person in doses too small to produce unpleasant 
sensations or other appreciable effects, its influence might 
be considered absent, yet in the same doses, when nausea 
and vomiting occur in disease, with irritation of the parts 
and disturbance of function, it tends to correction of the 
abnormal state. This is an example of a great number of 
instances where the large dose disturbs or arrests normal 
function, while the small one conduces to restoration when 
the disturbance is that of disease. 

Dose, then, would divide a large number of remedies 



THERAPEUTIC CLASSIFICATION. 19 

into two general classes, of which we might christen one 
dynamical, its agents acting in unison with the forces of 
normal life, and the other statical, because its members 
oppose or arrest, for the time at least, such action. 

Not all remedies, however, can belong to these two 
classes ; quite a number of agents exhibiting excellent 
dynamical properties, manifest little if any physiological 
action, even in exorbitant doses. Olden-time therapeu- 
tists would have pronounced such agents inert, because 
of this, but the excellent clinical effects resulting from 
their use fail to justify such a verdict ; triturated oyster 
shell (calcarea ostrearum) is one of these, and silica, an- 
other, both possessing rare dynamical properties — as well 
as a number of others, which the materia medica could ill 
afford to spare. 

Both kinds of action are of value in the management of 
disease, when the physician is liberal enough to avail him- 
self of them ; but the average homeopathist disdains the 
physiological effects of drugs, except so far as they serve 
as indicators for use in dynamical doses, while the adher- 
ent of old prejudices is unwilling to entertain belief in the 
attenuated doses essential to successful dynamical action. 
Thus for many years lack of a genuine eclectic spirit 
hampered the progress of medicine, until it fell behind in 
the march of the ages. 

In the growing interest in the study of dynamical drug 
action, importance of the frequent necessity of the uses 
recognized by the old classification, should not be forgot- 
ten. The derivative effect of a drug, or the detergent ac- 
tion of another, or the soporiferous influence of a third, 
may be found the action most desirable, for the time, at 
least, in the treatment of a given case. Emetics, though 
for a time perverters of function, are an important item of 
the wise physician's resources — not confined to those 
cases where simple evacuation is indicated, by any means. 



20 THERAPEUTIC CLASSIFICATION. 

The follower of Thonisonian methods might attempt 
too much with this class of remedies, and do harm by in- 
discriminately subjecting his patients to emesis ; this, how- 
ever, ought not to be employed as an argument against 
their proper use to fulfill important indications when so 
demanded. Cathartics were abused in the days of igno- 
rant and superstitious medicine, until many physicians, 
as a result of the reaction consequent upon a better knowl- 
edge of physiology, avoid them altogether; still, while 
we realize that cathartics disturb the alimentary functions, 
and are but sorry promoters of secretion as a rule, a peri- 
staltic persuader is occasionally very essential to a suc- 
cessful and satisfactory practice. As much might be as- 
serted of the majority of agents recognized by the old 
classification. Then why abandon them? better retain the 
old, and add the new. 

The importance of minuteness of dose, in order to de- 
rive satisfactory dynamical results, must not be forgotten. 
An abnormal state of a tissue or organ may render it ex- 
tremely sensitive to drug influence, and all the good effect 
hoped for may be neutralized by impressing the part too 
powerfully. People are, ordinarily, unfavorably impressed 
with the idea of influencing vital processes with the mi- 
nute doses proposed by those who deal in the dynamical 
action of drugs. Especially is this so with the student, 
if the ideas of therapeutics which have characterized the 
old school have been his early impressions. Much of the 
fine and accurate knowledge of therapeutics has been lost 
through prejudice. 

Dynamical remedies may be divided into two groups, 
though the line between them is not clearly marked in all 
cases: From the inception of embryonic life the two essen- 
tials of existence and development are plasma and plastic 
force, and these essentials are paramount throughout the 
life of the individual. There must be a properly prepared 



THERAPEUTIC CLASSIFICATION. 21 

material for the supply of the body, and this must be 
properly distributed, while each part must possess the 
ability of appropriating that "which is most needful for its 
special wants. 

The plasma remedies include but a small number com- 
pared with those of the other class. Alteration or depra- 
vation of the fluids of the body offers indications for their 
use. Sodii sulphis is a prominent one of this class, indi- 
cated when the blood depravation manifests itself in pal- 
lidity of mucous membranes, with pasty white coating on 
the tongue. Acidum suiphurosum is indicated when the 
tongue is coated brown, and brown sordes collect on the 
lips and teeth ; acidum hydrochloricum, where the tongue 
presents the color and general appearance of beefsteak. 

Such are examples of corrective action by virtue of 
chemical influence — at least in the cases of sulphite of so- 
dium and hydrochloric acid ; for blue litmus paper is red- 
dened by contact with the pasty white coating of the for- 
mer, while the slick, dark-red tongue of the latter affords 
proof of alkalinity by the characteristic reaction with red 
litmus. 

However, it is not impossible that a dynamical action 
may attend, the action being chemico-vital, instead of a 
purely chemical one. Certainly, in the case of baptisia 
the corrective action cannot be considered a chemical 
one, the influence being exerted dynamically entirely, as 
there is no evidence of its being an antiseptic outside the 
body ; and yet it proves a corrective of rare virtue in cer- 
tain cases when administered internally. 

The subject of " potomaines " is one at present engross- 
ing professional attention. These are a class of putrefac- 
tive alkaloids generated by bacteria, in septic processes in 
organic matter. Since attempt to discover remedies de- 
structive of bacterial organisms has apparently proven 
futile, a disposition seems manifest on the part of some 



22 THEKAPEUTIC CLASSIFICATION. 

of the germ theorists to abandon this line of research, 
and seek to correct the evils of germ infection by neutral- 
izing or eliminating the poisons generated — though not all 
potomaines are poisonous. 

Each class of bacteria is supposed to generate a spe- 
cific ferment ( potomaine ), which is peculiar to the special 
disease it creates. For example : The typhoid fever bacil- 
lus can only produce the potomaine typhotoxine, while 
the bacterium of tetanus must be present for the gener- 
ation of tetanine. Such propositions, though yet hardly 
ripened, approach the position long held by the Eclectic 
school; and though we have not given as much attention 
to the microscopy of disease, we have more than antici- 
pated the results of their search by recognizing, virtually, 
the presence of putrefactive ferments, and specifically 
adapting remedies to their correction, the credit being due 
in great measure to the clinical observation and inductive 
reasoning of Scudder. 

It is not the purpose to more than allude to the plasma 
remedies in this place, for they will be fully treated in 
a special department. Suffice it to remark that they con- 
stitute an important, frequent, and satisfactory source of 
supply to every inquiring liberal physician. 

The plastic remedies are the tissue remedies proper ; 
they possess an affinity for the tissues, selecting and dif- 
ferentiating, in a manner entirely unexplainable. The nu- 
clei of the cells are probably the primary point of impres- 
sion ; at least, the nutritive quality of the cell is gener- 
ally believed to be the elaborating center, through which 
new protoplasm passes, upon its arrival, before being 
adapted to the uses of the part. Thus every cell is spe- 
cially constructed for its purposes, and if normal condi- 
tions fail, the therapeutic agent probably impresses it to 
restore the proper activity. Let us suppose so. 

Tissue remedies act in various ways upon a given part. 



THERAPEUTIC CLASSIFICATION. 23 

One may influence the nutrition of the cells, or of the 
nutritive center, in such a manner as to encourage retro- 
grade metamorphosis and the building of better structure, 
thus being applicable to chronic lesions, where there is 
considerable alteration of tissue. Another may influence 
the circulation in the part through the vaso-motor center, 
and thus relieve acute congestive conditions. A third 
may affect specifically some function, and still another 
may be adapted to a painful state of the part — a myotic 
or neurotic agent. 

Knowledge of the selective affinities of drugs may be 
determined by experimentation, — by what the homeopa- 
thist would term "provings, " or the modern old-school- 
man the "physiological action" — but such differentiation 
as that here referred to must be determined by clinical 
experience. 

It will be observed that this variety of purposes must 
demand a multitude of remedies; we cannot construct a 
materia medica upon this plan, by reducing the number 
of agents. The most effective materia medica will include 
a goodiy list of remedies influencing each part collect- 
ively, but embracing a variety of therapeutic properties, 
that numerous changes may be rung, to adapt the treat- 
ment to the different pathological conditions liable to be 
present. 

Plastic remedies influencing a part might be divided 
into remedies of nutrition, of function, remedies for vas- 
cular disturbance, for myalgia, for neuralgia, etc, ; but 
this might prove confusing, as two or more of these prop- 
erties may belong to the same drug, and it would there- 
fore be perplexing to attempt such arrangement ; it would 
be difficult to set apart a list of nutrition remedies which 
do not influence in greater or less degree the functions 
of the same part, and these might relieve painful states 
by reason perhaps of such influence. 



24 THEEAPEUTIC CLASSIFICATION. 

It would be better to divide the plastic remedies ioto 
classes to correspond with anatomical parts influenced. 
For example : Remedies which influence the osseous sys- 
tem might be grouped, without reference to any common 
property except that of affinity for such structure. With 
this in mind the differentiation would not be difficult, and 
if doubt existed as to the proper selection, such grouping 
would readily suggest the agents for trial by rotation; 
and this plan might apply to every tissue of the body. 

But .we must not stop at classification upon the basis 
of structure alone; every organ possesses its group of 
remedies, which manifest specific affinities for it. This 
fact was recognized in much of the crude practice of the 
ancients, which seems to have consisted largely in the 
administration of purgatives, until "regular" medicine 
added digitalis for cardiac affections, cantharis for its in- 
fluence upon the genito-urinary sphere, and a few other 
inconsequential specifics. Organopathy, — therapeutics 
directed to the influencing of organs, — however, seems to 
have received tacit recognition throughout the history of 
medicine, though much of it has been of a very crude 
character. 

Plastic remedies become plasma remedies in an indirect 
way when they specifically correct perverted states of the 
blood-making organs, when they regulate hepatic abnormi- 
ties, by which there is an overflow of bile into the general 
circulation, or when digestive disorders result in abnormal 
elements to be precipitated upon the kidneys. There is 
such an intimate relationship existing between all the 
vital processes, that complete classification of dynamical 
action would be impossible. 

Just where the line of demarkation between functional 
and structural disease lies, is a fine point for discrimina- 
tion. "Whether it be possible," says Green, "for the 
function of an organ or tissue to be abnormally performed 



THERAPEUTIC CLASSIFICATION. 25 

quite irrespective of any alteration in its structure, admits 
of some doubt. At all events, as our methods of minute 
investigation improve, and our knowledge of morbid his- 
tology increases, the class of functional diseases grows 
less; and although there still remain a large number of 
diseases in which we are unable to recognize any alter- 
ation of structure, and which, therefore, must still be de- 
scribed as functional, it is probable that all disease will 
ultimately be found to be attended by more or less struct- 
ural change." 

Upon such grounds it would be quite proper to class 
all those remedies markedly influencing the functions of 
an organ or part as plastic remedies, though in doing so 
more or less encroachment on the domain of the plasma 
remedies would result in certain instances. However, it 
is not technical classification we should aim at so much 
as rational methods of grouping, for satisfactory selec- 
tion. 

Bacteriology has failed to develop an extensive list of 
agents adapted to the destruction of micro-organisms of 
disease. Still, a few remedies have promised something 
in this line ; ozone has earned some reputation as an agent 
capable of arresting the inroads of cholera, — a disease 
supposed to be due to the presence of a specific bacillus, 
when generated in hospital wards devoted to its treat- 
ment, — and it has also been found serviceable as an inhal- 
ant to destroy certain organisms in the blood stream. 
Peroxide of hydrogen, bromine, chlorine, and other drugs, 
have been suggested, but they have not yet attained emi- 
nence ; it remains to be proven that they are worthy to 
be classed among germ-destroying agents. In fact, some 
bacterial forms, as those of diphtheria, seem to be almost 
indestructible, resisting with surprising vitality immer- 
sion in boiling water, and strongest carbolic acid. 



26 THE PRINCIPLES OF SELECTION. 



THE PRINCIPLES OP SELECTION. 

The selection of remedies for disease expressions is a 
subject which may be discussed with profit, for it is one 
requiring much thought and study in order that the high- 
est excellence may be attained in the art of adapting ther- 
apeutic agents to the various phases of pathology. 

The characteristic of modern medicine is, that in this 
respect — as well as others — an attempt to proceed on ra- 
tional grounds is prominent in the mind of the physician; 
the custom of grouping symptoms, giving them a name, 
and applying stereotyped treatment, has become obsolete. 
The progressive physician of the present seeks to thor- 
oughly analyze each individual case, before proceeding 
with its treatment. 

There is too much positive knowledge of therapeutics 
at the present time to admit of an excuse for empiricism, 
except perhaps in a few instances where the testing of 
drugs is the object, or where obscureness of diagnosis or 
want of clearly defined expression leaves no alternative ; 
there are many avenues open to intelligent prescribing. 

Rational medicine rests upon the foundation of a liberal 
education, embracing knowledge of the laws of normal life, 
of the processes of disease, or abnormal life, of the physi- 
ological action of drugs, of their dynamical action and 
clinical effects, as well as the value and applicability of 
many adjuncts to therapeutics, such as electricity, mas- 
sage, and climato-therapy. 

It is an important qualification to be able to know 
when not to administer drugs, as well as to know what to 
select at the proper time. The principles of selection 
should involve so wide a knowledge of the collateral 
branches of medicine that the physician would make no 
mistake in this respect. The practitioner who persists in 



THE PRINCIPLES OF SELECTION. 27 

administering pulsatilla, ieontin, cimicifuga, lillium tigri- 
num, sepia, or hydrastis for the symptoms arising from 
irritation due to chafing of a lacerated, everted uterine 
cervix needs to extend his reading and widen his lines of 
thought. There are many conditions, also amenable to 
drugs, which may be relieved more promptly by other 
measures and measures which it would be profitable for 
the practitioner to adopt. Saint Vitus' dance may some- 
times be cured with drugs, but electricity so infinitely 
excels their action that they are not worthy of recognition 
in such a case. An excessively troublesome erythema 
may be made to yield to rhus, apis, juglans, or arctium 
lappa; but as the relief of the troublesome pruritus 
might be the desideratum and in fact the indirect cure, 
a topical application might be found the short and com- 
mendatory way of affording relief. The most scientific 
method is that which succeeds best. 

THE OLD CLASSIFICATION 

Offers many indications for remedies which are not wor- 
thy of mention here, for they are so simple and appar- 
ent that little study is required for their recognition, 
while many of the indications must become obsolete for 
reason of the adoption of modern ideas which ignore their 
utility. The physician who marches not with the prog- 
ress of the times but remains wedded to old ideas is 
laboring under an incubus. 

The old classification arose when disease was regarded 
as an entity — a tangible devil to be forcibly expelled from 
the body, and the harsh and violent agent, one which 
commended itself by its unpleasant effects, even though 
it prostrated the patient nigh unto death, was employed. 
Large doses of powerful drugs was the fashion then and 
unfortunately a fashion it has been very difficult to 
change. 

The conclusions arrived at by the ancients as to the ex- 



ao THE PKINCIPLES OF SELECTION. 

pressions of disease were often crude and erroneous, for 
their light was a dim candle beside the better illumi- 
nation of the subject afforded by later advances in physi- 
ology, pathology, and therapeutics. Constipation was 
considered an infallible indication for the use of a cathar- 
tic. Diarrhea demanded an astringent. Pain called for 
a narcotic. 

We now realize that though constipation may occasion- 
ally indicate the need of a cathartic, it may really call for 
the very reverse ; if physiology teaches any lesson here it 
carries the conviction that the customary use of cathar- 
tics is bad practice. Astringents used to arrest a diar- 
rhea, might aggravate an irritation upon which the flux 
depended and thus prove but sorry relievers of the condi- 
tion, even though temporary arrest might follow; the 
modern therapeutist relies upon something more specific 
than the general property of astringency, in such cases. 
Narcotics induce a temporary suspension of nervous sen- 
sibility — paralysis — for a time, and also suspend in a 
measure important vital functions, and are to be avoided 
when there are reliable indications for remedies which 
relieve by correcting perversion of vital processes giving 
rise to pain. 

The rationalism of early medicine was of the most 
primitive kind. There is a simple rationalism in the use 
of an emetic to remove morbid accumulations from the 
stomach, and in the use of a cathartic to rid the aliment- 
ary canal of irritating material, which, retained, might be 
the occasion of disease of that part. It is certainly 
reasonable to administer a narcotic to relieve severe pain, 
until curative measures succeed, and in the use of a hyp- 
notic to invite slumber when insomnia has distracted the 
nervous energies ; or of a counter-irritant to divert inflam- 
matory action from an important internal organ ; but all 
this is so simple that the ordinary persoai grasps the idea 
almost as readily as the physician. 



THE PRINCIPLES OF SELECTION. 29 

Such rationalism constitutes the simple elements of 
practice and is extremely clear in its propositions. It 
consists in the application of agents for the removal of 
causes of disease, which are so prominent as to be rec- 
ognized by the unsophisticated, — of the paralyzing of the 
entire nervous system for the relief of localized pain, or 
the lulling of hyper-sensitive nerves through the charging 
of the blood with lethal agents, — simple propositions 
familiar to the ancients though some of the agents em- 
ployed may be new. 

If this practice constituted the sum total of medical 
rationalism, the elaborate and laborious researches of the 
biologist might as well have been neglected. Such means 
and measures are largely perverters of function, and 
though they may indirectly serve as restoratives, the pri- 
mary action should be dispensed with at as early a period 
as is consistent with success. 

DYNAMICAL THERAPEUTICS. 

But a change has taken place in the ideas of therapeu- 
tics. Disease is no longer regarded as an entity, — some- 
thing to be driven out, but as an absence or perversion 
of some factor essential to healthy action, a condition 
calling for such means as tend to foster, encourage, and 
restore vital activities, — as a condition in which medicine 
may encourage a lagging function, neutralize a septic ten- 
dency, or supply a lacking element; and as a condition 
precluding the embarrassing effects of heroic doses of 
drugs, if healthy action is to be readily restored. 

When we enter upon the domain of dynamical thera- 
peutics, we deal with a class of agents which directly and 
specifically influence vital operations. It is no roundabout 
action we are now considering ; the function of dynamical 
remedies is the direct influencing of disturbed processes 
in such a manner as to turn them into normal channels 



30 THE PRINCIPLES OF SELECTION. 

and bring about restoration of physiological life. We 
here deal directly with the corrective and restorative 
properties of drugs and their affinities for affected parts, 
organs, or functions. 

A rational application of dynamical therapeutics must 
rest upon the foundation of biology, the science of life. 
Not that it must be expected to always prove a remedy 
upon the healthy person, in order to render its place in 
the materia medica definable, but the remedy applicable 
to each function of life must be learned either by experi- 
mentation or by clinical experience, and when disease oc- 
curs, with deviation of that function, the remedy which by 
its selective influence impresses the part or function fa- 
vorably, must be administered in doses just sufficiently 
large to exert a kindly restorative influence. 

Remedies hardly or never succeed in completely restor- 
ing a part after its histological elements have been al- 
tered, for though apparent recovery may follow judicious 
medication, an increased susceptibility to disease remains 
for a long period if not for a life-time ; still, its vitality 
may be improved and its functional activity augmented 
until an apparent state of health exists, and with a knowl- 
edge of the remote effects of disease, the vitality of the 
part may be guarded from exposure and injury to the full 
and satisfactory performance of all its offices. 

It will be long before the scheme of dynamical thera- 
peutics can be perfected. The therapeutist must bide the 
time of the physiologist. The mystery of vital force is 
not yet explained. The complexities of the nervous sys- 
tem — the location of centers of function, the bewildering 
maze of reflexes, the puzzle of ganglionic masses and de- 
cussating fibers — the functions of the ductless glands, 
these and other problems must be solved before it can be 
hoped to complete a scientific system of therapeutics. 

Meanwhile the work of the past can be continued — the 



THE PRINCIPLES OF SELECTION. 31 

annotation of isolated facts, which may sometime serve 
as links in a completed chain of reliable data. Until then 
it may be best for medical men to regard the present 
knowledge in a candid light — thankful for what has been 
acquired, though the information already possessed may 
seem but as a series of uncertain glimpses into an endless 
field of supply. 

Do the best we can, there is more or less uncertainty 
about the practice of medicine. Careful grouping of 
agents according to the part or function impressed nar- 
rows the field of uncertainty down to a point much 
short of older methods of gross empiricism, but not 
enough is yet known that a drug may always be adapted 
to a given case on first trial. In order to overcome such 
objection, a number of agents should be at command; we 
should be able to draw upon a list of several remedies 
similar in action, but each possessing some individual 
merit and peculiarity; then if one should fail we are not 
at loss for other means. 

RELATION OF PATHOLOGY TO DYNAMICAL THERAPEUTICS. 

Investigation of the nature of disease has advanced 
the standing of medicine greatly in modern time. The 
post-mortem study of diseased structure — pathological 
anatomy — has done much toward affording clearer ideas 
of morbid processes and suggests g rational methods of 
treatment. Better and more appropriate classification of 
disease has been the result of added pathological knowl- 
edge, and it has moreover cleared up some obscure phases 
of etiology, thus affording important assistance in the 
adaptation of remedies to abnormal states. 

Knowledge of pathology is an important aid to the 
therapeutist. Take, for example, such a disease as ty- 
phoid fever. Here we may have a variety of therapeutic 
indications manifested during an epidemic, or even during 
the progress of a single case, but in all a knowledge of the 



32 THE PRINCIPLES OF SELECTION. 

fact that much of the force of the disease is usually spent 
upon the intestinal structures — Peyers' patches — prompts 
us to guard these tissues from beginning to end, and we 
administer baptisia for this purpose, without regard to 
other indications or remedies, believing that it specifically 
influences these parts to sustain their vitality. 

In numerous other cases the same principle applies. 
With a knowledge of the pathology of a case, of the part 
liable to suffer damage from the affection, or of the tis- 
sues suffering most severely, and of remedies which influ- 
ence the restorative powers of the part favorably, we 
may be able to make our therapeutic selection upon 
rational grounds. 

Knowledge of pathology also enables us to direct our 
treatment to the correct purpose when there seem to be 
indications for remedies in an opposite direction. Take 
senile gangrene, for instance. Here the natural impulse 
with one unacquainted with pathology would be to at- 
tempt to control the progressing death of an affected 
extremity, due to occlusion of the supplying artery, with 
stimulants and antiseptics locally and constitutionally, 
when pathology would suggest the administration of such 
remedies and diet as tend to aid the circulating fluids to 
hold in solution calcareous material and dissolve obstruc- 
tions in the arteries, already formed, that blood may per- 
meate the starved tissues. 

A knowledge of the pathology of fever enables us to 
rationally provide by therapeutic means, through the 
employment of the sedatives, nourishment, and proper 
management in other respects, against the grave tissue 
changes that might otherwise lead to fatal results. 

However, important as the subject is, pathology at- 
tracts but little attention in the field of therapeutics — in 
the adaptation of remedies to disease. Here we must 
rely upon expressions — symptoms which seldom have ref- 



THE PRINCIPLES OF SELECTION. 33 

erence to nosologically indicated conditions, stereotyped 
treatment after nosology being of the things of the past. 
There must be a direct relationship between expressions, 
indications, and remedies, without particular regard for 
pathology. Here symptoms might not afford definite in- 
dications of stated pathological states and might manifest 
themselves at a distance from the actual place of morbid 
process. 

Observation of tissue activities is as difficult during 
disease as in health. Post-mortem conditions cannot dem- 
onstrate the processes by which the alteration of pre- 
viously healthy tissue is brought about, nor can these 
processes usually be studied during activity. 

True, the web of a frog's foot, the ear of a rabbit, or 
a fold of the intestine of one of the lower animals, may 
afford an opportunity of observing the prominent changes 
taking place during the course of inflammatory action, but 
the symptoms, pain, heat, redness, and swelling, are taken 
into account more after all than these, in the selecting of 
remedies, for the relief of the condition. However, the 
skillful practitioner bears in mind his knowledge of pa- 
thology, and it constitutes the basis or underlying princi- 
ple of all his prescribing. 

Pathological processes in the skin, the epithelia, and 
the eye, are open to ready and frequent observation, yet 
the therapeutics of diseases of these parts have not pro- 
gressed more rapidly than of those not so situated. Cer- 
tain of the functions of cells, as motion, growth, and repro- 
duction, can be observed through the microscope, and some 
of the changes of disease thus made note of, but to trace 
connection between such changes and the impressions of 
a therapeutic agent, or to be able to adapt an agent to 
specific cell function, must depend upon experimental re- 
search and clinical experience. 

Then we can only infer, perhaps, that particular patho- 



34 THE PEINCIPLES OF SELECTION. 

logical processes have been influenced from the fact that 
physiological action has been re-established rather than 
from ocular evidence that specific changes have been 
wrought. The manner of action of most remedies is un- 
known, except as regards the gross results. 

True, Brown-Sequard observed contraction of the capil- 
laries to follow the introduction of belladonna into the 
circulation, and the corollary of its administration in cap- 
illary congestion with successful result followed. Con- 
traction of the arterioles has been observed to result 
from the influence of ergot and hydrastis, the latter caus- 
ing contraction of the muscular fibers of the coats of the 
vessels without producing a general action upon the mus- 
cular system at large ; but not very much of value thera- 
peutically has accrued from these observations, the em- 
pirical use of both agents for disease expressions having 
afforded more practical knowledge ; for the circulation ex- 
erts but a relative influence upon cellular and intercellular 
changes. Still, the importance of the physiological action 
of drugs should not be underestimated ; all knowledge of 
this character will sometime find its legitimate place. 

Doubtless, knowledge of pathology will afford some aid 
in the selection of the remedies of the future, as it has in 
the past ; and knowledge thus gained will be of reliable 
and substantial character, not to be supplanted by more 
positive measures ; but it will hardly be possible for the 
older plans of experimental test and clinical observation 
to be completely dispensed with. 

Even in parasitic diseases, pathology only informs us of 
the nature of the affection and suggests the plan of treat- 
ment, not the means. The specific agent, to abate the 
abnormal condition must be determined by experimenta- 
tion — by clinical research — exploration in a field entirely 
foreign to pathology. 

The idea of the entity of disease has been a stumbling- 



THE PRINCIPLES OF SELECTION. 35 

block in the study of therapeutics. Pathology has been 
investigated with tireless zeal for years, with the belief 
that the knowledge thus acquired would enable the physi- 
cian to apply the corrective means in like cases. 

But we should recollect that pathological processes are 
not subject to the same laws of constancy as those of 
healthy life. It is a biological principle, that in health 
the efforts of nature are in the direction of normal forms 
or types and normal functions, and these efforts are per- 
sistent through cycle after cycle of time, environment and 
other physical influences bringing about normal changes 
but slowly, ages being required for their full development. 

Pathological processes are vital processes running riot, 
except, perhaps, when disease results from lack of nutri- 
tion. The character of disturbance or the normal pecul- 
iarity of the part may impress the pathological elements 
with characteristics rendering them susceptible of clas- 
sification, but there is no fidelity to fixed forms except in 
the influence that normal processes may still exert under 
the embarrassment of morbid surroundings. 

RELATION OF PHYSIOLOGY TO DIAGNOSIS AND THERAPEUTICS. 

The successful correction of pathological conditions 
by therapeutic means then will depend upon the favora- 
ble influencing, not of pathological processes but of the 
normal energy that may remain. The sooner we can in- 
fluence this element favorably after departure from health, 
the more readily we may turn the deviated forces back 
into normal channels and stay the gross results of abnor- 
mal deviation — pathological change. 

Evidently therapeutics could not be systematically ap- 
plied to pathological states, for there would be no unifor- 
mity of condition for constancy of application or reliability 
of action. There must be a reciprocity of action between 
the influence of the remedy and the normal functions of 
an affected part, in order that recuperation may follow. 



36 THE PKINCIPLES OF SELECTION. 

Health then being the point of departure, it should 
constitute the standard of measurement with which every 
abnormal state should be compared. A knowledge of 
physiological constants should be familiar to every physi- 
cian, that character of deviation as well as probable 
amount may be estimated, the estimation looking toward 
therapeutic selection, or drug diagnosis, as well as diag- 
nosis upon the basis of disease nomenclature, and progno- 
sis. Nor is a knowledge of physiology as taught by 
books all to be desired. The senses of the practitioner 
must be trained to accuracy to detect many expressions 
that a knowledge obtained from written authorities alone, 
would leave out of the question. 

An intimate personal acquaintance with the expressions 
of health, one based upon all the trained senses can ob- 
serve or detect, is as essential to successful drug selection 
as a knowledge of written physiology, for much that can 
be impresssed in this way cannot possibly be taught 
by books. This is the part of the physician's education 
which, becoming better and better developed, as he de- 
votes himself to his calling, assists in those happy percep- 
tions and impulses that often help him out of dilemmas, 
and to which the term "intuition" has, not inaptly, been 
applied; he thus learns to observe what words would but 
doubtfully express, but which his own senses assure him 
to be deviations from health, and at the same time indica- 
tions for this or that remedy. 

The expression of the healthy eye, its luster, the condi- 
tion of the pupil, the facial expression, the normal color, 
shape, and consistency of the tongue, its freedom from 
coating, the color, transparency, and suppleness of the 
skin, the soft, full, regular pulse, the easy and rhythmical 
rise and fall of the chest in respiration, the absence of ab- 
normal odor, the comfortable pose and movement, — all 
these and other expressions of health impress the senses 



THE PRINCIPLES OF SELECTION. 37 

of the observer so that he recognizes deviation with 
readiness, and aided by a knowledge of the affinities and 
other characteristics of drugs, he connects the deviation 
with some remedy specifically adapted to the correction 
of the disordered function. 

But valuable as superficial inspection proves, it may, 
if trusted too far, become misleading and commit the 
physician to error. It cannot supply the place of well-ad- 
apted physical exploration, though it may be indispensa- 
ble in leading up to the point where positive investigation 
can be satisfactorily begun. Physical diagnosis, auscul- 
tation, percussion, mensuration, palpation, thermometry, 
microscopy, urinary analysis, all the tests which science 
can afford, are of value in practice to aid in the selec- 
tion of remedies. 

The sense of touch might convey an idea of the temper- 
ature which the thermometer would materially correct; 
impressions of the character of the respiration formed 
from superficial inspection, may be very much altered 
and even proven eminently erroneous, and an entirely dif- 
ferent line of remedies suggested upon resort to careful 
physical exploration of the chest ; urinary analysis may 
convince the practitioner that his deductions based upon 
a superficial inspection are in error, and correct impres- 
sions which might lead to useless and harmful medica- 
tion. With the normal standard as a guide, then, we train 
the senses to lead us up to the point where more exact 
methods of selection can be begun with well-defined pur- 
poses. 

Knowledge of normal conditions enables the practi- 
tioner to readily recognize abnormal action, and knowl- 
edge of drug individuality combined with this enables 
him to readily refer, in many instances, to the appropriate 
remedy. 

Suppose the pulse and respiration suggest cardiac de- 



38 THE PBINCIPLES OF SELECTION. 

rangement, the suggestion must take more definite form 
before the practitioner can rationally decide upon the 
proper remedy, and a knowledge of the normal sounds en- 
ables him, upon auscultation, to determine still more ac- 
curately the condition present, and decide as to its thera- 
peutic requirements. 

The muffled, labored sound of effusion would suggest 
digitalis, convallaria, adonis, or apocynin; the rasping 
sound of valvular obstruction silica or iodide of potas- 
sium ; the feeble, tremulous sound, indicating loss of pro- 
pulsive power, would call for nitro-glycerine, strophan- 
tus, or lachesis; the irregular, or intermittent sound 
would suggest cereus speciocissimus, or Scutellaria; etc. 

The grouping of remedies in dynamical therapeutics 
can be properly made only upon the basis of physiology. 
Remedies influence function, and in this manner effect res- 
toration, when diseased structure can be repaired; they 
sustain no direct relationship to disease except by their 
influence upon normal structure, except in such cases as 
those of parasites, where the disease is an actual entity 
and requires expulsion. 

THE BLOOD. 

Naturally, in a general survey of therapeutics we essay 
those first which have relation to the fluids of the body. 
Old pathologists divided disease for study into disease 
of the fluids and disease of the solids. That any great 
advantage was derived from this classification remains a 
question ; but from the fluids are built up the solid parts ; 
the fluids are largely the solid parts in process of prepa- 
tion, and it therefore seems more like beginning at the 
foundation of the subject to begin with parts approaching 
the completed structure. All parts of the body, fluid and 
solid, have been separated from the blood or else are 
constituent portions of it. 
The blood serves the purpose of a navigable stream, 



THE PKINCIPLES OF SELECTION. 39 

through which all parts of the body are reached by nour- 
ishment, medicines, and toxic agents, while certain parts 
of it, the red corpuscles, constitute carriers to convey 
oxygen from the lungs to the tissues, and return, laden 
with carbon dioxide. It also represents the aggregate 
of elements, in various stages of development, which are 
passing forward to the point fitting them for reception by 
the body, as well as certain elements of former structures, 
which have been broken down, and are seeking exit. 

We have here, it will be observed, a circulating fluid 
subject to considerable normal variation in the proportion 
of its constituents at various times, and yet one very eas- 
ily contaminated by causes of disease, and one which 
may become, in a measure, the disturber of its own rate 
of movement, inasmuch as it circulates in, and supplies, 
the vasomotor centers. Its quality also determines, in 
many respects, the quality of the solid parts sup- 
plied by it. 

Anatomists divide the blood into plasma and corpus- 
cles, and divide the corpuscles into two classes, red and 
white. The plasma, though a certain portion of it be- 
comes solidified upon exposure to the air, represents the 
fluid portion, from which is obtained all the tissue sup- 
plies, except oxygen, and which holds in solution all the 
excretions, except carbon dioxide, these, as aire ad v re- 
marked, being transported by the red corpuscles. The 
white corpuscles probably represent broods of red corpus- 
cles in embryonic state of development. 

BLOOD-MAKING. 

Blood-making is an indispensable source of every func- 
tion, and upon it depends the foundation of every 
structure. If we could know all the secrets of this proc- 
ess, and were able to adapt remedies to them with the 
certainty that we adapt phytolacca to the mammary gland 
in mastitis, collinsonia to the rectum iu hemorrhoids, or 



40 THE PRINCIPLES OF SELECTION. 

polymnia to the spleen in chronic splenitis, we could hold 
in abeyance many intractable forms of disease. But in 
the absence of positive knowledge we can only speculate, 
and though certain premises may seem to warrant some 
very positive conclusions, these are not yet indorsed by 
the acquiescence of physiologists. 

The pabulum is supplied by alimentation, through the 
portal circulation on the one hand, and through the 
lacteals on the other, the material reaching the general 
circulation from the portal, after being more or less elabo- 
rated by the liver, and from the lacteals after the im- 
pressions of the mesenteric glands have been made. 

These primary impressions are essential in order that 
the elements of food may be kindly received. If faulty 
glandular action permits food products to enter the blood 
in too raw a state, an effort is at once made by the emunc- 
tories to remove them as extraneous matter, and serious 
disease may result to these parts in consequence of such 
taxation. 

It is hardly probable that this new material is fitted to 
the important demands of the delicate operations of se- 
cretion and nutrition immediately upon introduction into 
the general system ; the anatomy and general functions of 
the lymphatic system suggest that it is exuded by the 
capillaries of the general circulation and returned to the 
blood stream through the lymphatic system, the suc- 
cession of glands traversed serving as a series of scaffold- 
ings by which it is successively raised to a higher level of 
excellence as a means of body maintenance. Possibly 
several rounds of this character may be necessary before 
the plasma is fitted for the offices of a storehouse for the 
needs of life. 

Much then must depend upon a normal activity of the 
lymphatic system. This has been recognized by thera- 
peutists as a correct proposition for a long time, and the 



THE PRINCIPLES OF SELECTION. 41 

class of remedies supposed to favorably influence the 
functions of the lymphatics has been regarded as an im- 
portant collection of remedial agents. However, little 
progress has really been made beyond a vague idea that 
the class known as alteratives produce some favorable 
influence upon the lymphatic system in scrofula and 
syphilis. 

Some authors stop short of this point in their ideas of 
blood-making, and propose to influence the entire process 
by the impression made by drugs upon the digestive func- 
tions. Good digestion is certainly important to assimi- 
lation, but the majority of cases of imperfect digestion 
depend more upon faulty action of those organs which 
elaborate the nutritive elements of the food after they 
have left the alimentary canal, than upon lack of diges- 
tive power. They are the result of that backward wave 
which might be likened to a smoking fire-place, due to an 
obstructed flue — to interference with the normal flow of 
the products of digestion through the liver and lacteals. 

With the blood-making processes in good action, func- 
tional dyspepsia can hardly exist, though we must recol- 
lect that local causes are often at work in faulty digestion, 
these casfts being the exception, however, rather than the 
rule. 

Faulty plasma-making may sometimes be corrected by 
supplying factors which the glands are unable to obtain 
from the food. The inorganic elements of the blood, 
though present in sufficient quantity in a mixed diet, may 
not be properly extracted and appropriated. Here these 
elements should be supplied by the therapeutist. Salts 
of sodium, potassium, lime, and magnesium, constitute 
valuable adjuncts in such cases. 

The mode of origin of the red blood corpuscles is yet a 
vexed question. In the embryo, there seems a marked 
similarity between red and white corpuscles as regards 



42 THE PRINCIPLES OF SELECTION. 

their appearance and properties, the only distinction 
being that of color. Here the red corpuscles are granu- 
lar, nucleated, exhibit amoeboid movement, and multiply 
by subdivision. Later in fetal life, non-nucleated red cor- 
puscles originate from the cells of connective tissue. In 
adult life this origin has been observed in the connective 
tissue of the marrow of bones. 

It is not unreasonable to suppose that connective 
tissue is the breeding-place, so to speak, of the red 
corpuscles, at least the locality in which they reach 
the maturity of adult life. The white corpuscles proba- 
bly represent a transitional state of broods of these 
cells; histologists record the fact of having observed red 
corpuscles protruding from white ones while they were 
moving along the capillaries, in support of this propo- 
sition. 

Originating in the connective tissue of the lymphatic 
glands, the white corpuscles are for a time bathed in a 
fluid purely nutritious. Entering the blood stream later, 
their actions are remarkable. Here they exhibit charac- 
teristics entirely at variance with those manifested by the 
red corpuscles, which hurrry along with the current as 
though impelled by some attraction. But the white cor- 
puscles lag, appear to adhere to the walls of the capilla- 
ries, and seem to possess an attraction for the surround- 
ing tissues. Closely watched, a white corpuscle after a 
time is seen to pass through the capillary wall into the 
connective tissue — a normal process termed " diapedesis," 
once supposed to be peculiar to inflammation, but since 
demonstrated as a vital characteristic. 

What is the significance of all this ? The lower forms 
of life present us with many examples of transitional 
states during which the development of the adult is pro- 
gressing from embryonic forms. Connective tissue cells 
have been proven as the origin of red blood corpuscles in 



THE PRINCIPLES OF SELECTION. 43 

certain cases. Connective tissues are liberally supplied 
with nutritive material and possess a remarkable power of 
abetting cell proliferation under such conditions as that of 
inflammation, which proliferation of new elements may 
fairly be regarded as a normal process exaggerated by the 
excitement due a hypersemic condition. 

Leucocytes may represent broods of red blood corpus- 
cles which, arriving near maturity, are conveyed to the 
connective tissues and there liberated for complete devel- 
opment, after which they enter the capillaries, through 
the attraction due their new endowment, and fulfill their 
mission of carriers of oxygen and carbon dioxide until 
aged, and broken up. 

Ked corpuscles have been observed to pass through the 
capillary walls, but that they pass inward during health 
we have not as yet testimony to affirm. 

However, clinical experience seems to indicate that 
those means which promote activity in the connective 
tissues are most effective in the correction of anaemia. 
General faradism, massage, — such measures as these can 
hardly be excelled in impoverished states of the blood 
where red corpuscles are lacking. As for medicament, 
iron often aggravates anaemic states, and is most impotent 
to bring about favorable changes, though normal proc- 
esses may restore patients being drugged by the various 
ferruginous preparations. 

Evidently, a few drugs exert some favorable influence 
upon the blood-making processes. Agents promoting 
functional activity of the lymphatic glands must promote 
the birth of blood corpuscles if here be their place of ori- 
gin, and remedies favoring activity of the connective 
tissue cells must further the process if here be where 
they hibernate until fully developed. Massage and elec- 
tricity permeate the tissues and reach the areolar struct- 
ures directly. Cuprum and a few other drugs, perhaps, 



44 THE PRINCIPLES OF SELECTION. 

specifically influence the blood-making organs, though 
the influence is feeble beside that of the agencies of the 
electrician and masseur. 

THE GENERAL CIRCULATION. 

The general circulation consists of the distribution, by 
the aorta and its branches, of oxygenated blood from the 
left ventricle of the heart to all the tissues of the body, 
and its return, after circulating in the capillaries, by the 
veins, to the right auricle. 

This circulation serves as a great irrigating system to 
the body at large. The heart acts as a force-pump to 
impel the blood onward in the elastic arteries, which 
throbbing under its impulse, aid by their elasticity in im- 
pelling the stream to the capillaries, where the real func- 
tions of the flushing begin. 

Here, as the blood slowly moves along the transparent 
delicate-walled canals, the interchanges between the 
stream and tissues take place. Pabulum passes through 
into the intercellular spaces for the nourishment of the 
histological elements, broken up and worn out material 
passes outward to drift away in the stream, oxygen re- 
sponds to the attraction of the tissues, and displaced 
carbon dioxide joins the red corpuscles for a journey to 
the outer world. 

The alternate pressure of the heart's impulse from be- 
hind, the attraction of the tissues for the newly oxygen- 
ated corpuscles, and other forces, perhaps, serve to move 
the mass steadily onward, until the changes having been 
completed, the veins gather up all the diffused fluid, and 
pass it through one gateway, the right auricle, into the 
vessels of the pulmonary system, for rejuvenation. 

Meantime important side issues have been going on. 
The abdominal aorta has contributed, through a number 
of large branches, blood to the abdominal viscera which 
perform certain offices of digestion and assimilation, thus 



THE PRINCIPLES OF SELECTION. 45 

setting apart a separate, peculiar circulation, the portal, 
and distributing a second set of capillaries — to the liver. 

The renal arteries have ramified into capillaries which 
have been in close relationship with glandular and 
osmotic forces that have separated a certain portion of 
nitrogenous waste material, in the form of a watery so- 
lution of urea, uric acid, and other elements, as urine ; the 
capillaries of the skin have been giving off other waste 
products, while the pancreas, liver, gastric glands, and 
other secretory organs, have been separating and ap- 
propriating from the general stream, certain substances 
for further use in the economy; thus secretion and ex- 
cretion perform their offices as a part of a harmonious 
plan, as the regular round goes on. 

The action of the heart is regulated by the influence of 
the cardiac nerves, and the caliber of the vessels deter- 
mined, through branches from the vasomotor centers, so 
that supply and demand, waste and renewal, are nicely ad- 
justed, the blood maintaining an even temperature of 
98.6° Fahri., the pulse or heart stroke numbering near 70 
and the respirations 15 to 18 per minute. 

But disease seriously disturbs this nicely adjusted equi- 
librium, and disarranges the entire economy; and disturb- 
ance of a single function is reflected throughout the entire 
arrangement. 

Suppose the blood is hurried along more rapidly than 
at the usual rate, respiration becomes excited, the heart 
and arteries respond to the stimulus and contract more 
rapidly, the governing centers becoming disturbed by the 
presence of excess of oxygen. Increased oxidation gives 
rise to increased temperature, for oxidation is a literal 
burning, and as the blood rushes upon its round with un- 
due rapidity, all the functions of growth, of secretion, and 
excretion, become disturbed. The urinary elements are 
now but partially removed, the skin becomes dry, secre- 
tion arrested, all the vital forces impaired, and destruction 



46 THE PRINCIPLES OF SELECTION. 

of tissue ensues, as evidenced by emaciation, debility, 
and, perhaps, impairment of the mental forces. 

Suppose on the other hand there be a failure in the im- 
pelling power of the circulation, — failure upon the part of 
the heart or blood-vessels to perform well ; the stream 
moves but slowly, and the capillaries are filled with blood 
but partially supplied with oxygen, for the pulmonary cir- 
culation receives but a compensating impulse. Oxidation 
of tissue, the removal of carbon dioxide, the distribution 
of pabulum, the transportation of waste material, go on 
imperfectly, the vital organs, and the nervous centers, — all 
parts are imperfectly stimulated, the blood becomes 
loaded with waste products and the entire body suffers. 

The normal rate of the circulation cannot be disturbed 
long before the quality of the blood deteriorates; this 
would result if lack of nourishment and increased breaking 
down of tissue, which must follow from disturbed circula- 
tory function, were the only causes, but a more important 
one, in many acute diseases, as fever and inflammation, is 
the generation of septic elements, — potomaines(?) which 
tend to seriously threaten the continuation of existence, 
through rapid development, and depressing influence upon 
the nervous centers. Blood depravation becomes mani- 
fest in numerous ways, but the tongue is an important in- 
dex here, not only to denote the advent of the septic ele- 
ment, but also to suggest the appropriate remedy for its 
correction. 

A febrile or inflammatory state does not continue many 
days before the tongue manifests the tendency to such 
changes, and when an indication of this kind becomes 
prominent, it should not be neglected. In treatment, it is 
well to recollect that the means which will control disturb- 
ance of the general circulation, applied early, may avert 
all danger of septic changes, by allowing the excretory 
organs to rid the blood of the disturbing and zymotic 



THE PRINCIPLES OF SELECTION. 47 

element, which tends to rapidly reproduce itself. Later, 
means looking to the direct correction of the depraved 
state must be applied. 

A special group of remedies, by virtue of their specific 
influence upon the cardiac and vasomotor centers of the 
general circulation, prove very reliable means of control- 
ling excitement, thus augmenting the functions which 
tend to free the blood of zymotic material. These have 
been termed the "special sedatives;" the leading ones be- 
ing aconite, gelseminum, jaborandi, and veratrum. When 
properly adapted, they calm and strengthen the govern- 
ing nervous centers, contribute to normal heart action, 
and arterial impulse, invigorate the capillaries, and in this 
manner encourage secretion, excretion, and all other func- 
tions concerned in the circulatory processes. 

But if septic changes have begun, the case has passed 
beyond the reach of these remedies, for while they may 
still modify the excitement, in a measure, the provoking 
element persists, and tends to the increase. Here a neu- 
tralizing agent must be applied, to act as a dynamical 
corrective. Then we have resort to the salts of sodium^ 
when the tongue presents the white coating and pallid 
mucous membrane, acids, when the dark red color of 
tongue and mucous membranes prevails, or other cor- 
rectives, as clinical experience has previously suggested. 
Baptisia serves as a corrective when prune-juice dis- 
charges, indicating gangrenous tendencies of mucous sur- 
faces, are present; chlorate of potassium, when feculent 
odors pervade the exhalations ; chloride of potassium, 
when plastic exudations threaten mischief; or lachesis or 
echinacea, when systemic poisons threaten paralysis of 
important nervous centers. 

But there are other ways of controlling vascular excite- 
ment than the use of the special sedatives, — means which 
are sometimes more prompt and efficacious. The hot 



48 THE PRINCIPLES OF SELECTION. 

pack, or, if the patient possess a vigorous constitution, the 
cold pack, or bath, or the spirit vapor bath, may accom- 
plish more in a few minutes than the sedatives can, 
safely, in as many days. These means will often serve to 
so thoroughly arrest the onset of a severe attack of fe- 
ver, as to leave but moderate after effects, and enable the 
practitioner to control the remaining disturbances with 
little difficulty. 

The effect of these remedies is not specifically upon 
the vasomotor centers; surface evaporation tends to refrig- 
eration, and the moist condition of the skin induced by 
such treatment must favor this action ; but doubtless the 
principal results are derived from the derivative influence 
of powerful determination to the superficial capillaries, 
thus diverting excitement from the vascular nervous cen- 
ters, while the same means encourage active removal of 
the disease-producing element, through the cutaneous 
vessels. 

The feeble circulation may depend upon heart failure, 
upon arterial lesion, upon want of capillary activity, or 
imperfect enervation of the vascular system. In acute 
phases, the capillaries are usually at fault; here minute 
doses of belladonna, liberal doses of capsicum, or the al- 
cohol vapor bath, singly or combined, as indicated, usu- 
ally serve the desired purpose. Venous fullness may call 
for hamamelis, carduus marianus, or podophyllin. 

THE PULMONARY CIRCULATION. 

The pulmonary circulation serves to distribute the ve- 
nous blood of the general circulation, which has been re- 
turned to the heart by the right auricle, to the pulmonary 
mucous membrane, through which the interchange of 
gases between the blood and inspired air takes place. 

The pulmonary artery conveys the venous blood 
through its bifurcations, which accompany the bronchial 
tubes and which ramify in capillaries upon the walls and 



THE PRINCIPLES OF SELECTION. 49 

septa of the air cells, and upon the walls of the intercellu- 
lar passages, from the right ventricle of the heart, which 
contracts aud relaxes synchronously with the left ventri- 
cle. These capillaries are gathered up after distribution 
and united, finally, to form four veins, — the pulmonary, 
which return the newly oxidized blood to the heart by 
the left auricle. The constant filling of this cavity is req- 
uisite to compensation between this and the general 
circulation. 

With regular and free supply of atmospheric air to the 
respiratory mucous membrane, and even and free distri- 
bution of blood to this part, and free exit through the 
heart into the general circulation, the offices of these or- 
gans and systems are carried on without commotion or 
friction; but a disturbance of the action of the heart, 
obstruction to the passage of blood through the pulmo- 
nary capillaries, or to the ready onward flow into the 
aorta, gives rise, at once, to imperfect oxygenation, dis- 
turbed respiration — in fact, disturbance of all the fluids 
of the body. 

The function of the pulmonary circulation is the sepa- 
rating of oxygen from the respired air, and its delivery 
to the general circulation through the left auricle, as well 
as the elimination of carbon dioxide, which unless re- 
moved promptly, soon becomes powerfully depressing to 
vital activities. The therapeutist recognizes the impor- 
tance of the pulmonary processes, and seeks to maintain 
them in the highest state of perfection, by every possible 
means. 

In therapeutic application, we find a number of direc- 
tions in which to aim our resources. Inflammatory states 
of the lungs, whether of the parenchyma or lining mem- 
brane, must be reached largely through the general circu- 
lation, and by such means as control cardiac and arterial 
excitement in other portions of the body. It must be 



50 THE PRINCIPLES OF SELECTION. 

recollected that the general circulation supplies the tissues 
of the lungs, through the bronchial arteries, with blood, 
which is returned to the general venous circulation by 
way of the vena azygos and superior intercostal vein. 

The sedatives, then, are applicable here, though they do 
not probably directly impress the pulmonary circulation, 
but instead exert their influence upon the vascular sup- 
ply from the aorta. 

By such means we seek to preserve the integrity of the 
pulmonary tissues — prevent engorgement, thus preserving 
open passages for the entrance of air to an unob- 
structed respiratory membrane, and, at the same time, 
preventing encroachment upon space devoted to the capil- 
laries of the pulmonary circulation. 

A few remedies manifest a marked predilection for the 
parenchyma of the lungs. One of these is asclepias 
tuberosa, which is one of the most reliable agents known 
in interstitial pneumonia. Veratrum, a more universally 
known agent, also is of great value, until the period of 
exudation arrives, when it should be abandoned for po- 
tassium chloride, which exerts a powerful influence to- 
ward restoration in such cases, by aiding in the successful 
removal of the exudates by absorption. 

The integrity of the respiratory membrane, is of great 
importance. Delicate and unobstructed capillary walls 
are essential to proper interchange of gases. Indura- 
tions and other pathological changes are to be averted as 
far as possible by the use of such remedies as tend to en- 
courage the plastic power of this part in its different 
localities. 

The respiratory mucous membrane manifests affinities 
for various remedies in different portions, which affinities 
may be found of use in inflammatory conditions manifest- 
ing tendency to chronicity. For example, the Schneiderian 
membrane may be influenced by atropia, potassium iodide 



THE PRINCIPLES OF SELECTION. 51 

or bichromate, or sambucus, etc. The larynx manifests 
affinities for aconite, arum, collinsonia, causticum, lachesis, 
and potassium bichromate ; the trachea for nitrate of san- 
guinarina and sticta pulmonaria ; the smaller bronchi for 
tartar emetic, ipecac, lobelia, and myosotis. The entire 
pulmonary mucous membrane is promptly influenced by 
calcarea carb., when its nutrition is at fault. 

"We directly influence the pulmonary circulation 
through cardiac remedies; indeed, the functions of the 
heart and pulmonary circulation are so intimately related 
that their therapeutics can hardly be separated. Reme- 
dies then which strengthen and accelerate cardiac action 
add to the activity of the blood in the pulmonary vessels, 
while those which sedate and steady cardiac function, 
produce a similar effect upon this system. 

OXYGEN ARTIFICIALLY SUPPLIED. 

Oxygen, in its influence upon the removal of worn-out 
material from the system, is far-reaching. Thoroughly ox- 
idized waste products are readily removed by the emunc- 
tories with little tax upon their powers, but material 
not perfectly incinerated, may cause such serious diffi- 
culty as to impair the structure of the kidneys and 
other emunctory organs. 

When the offices of the pulmonary circulation are im- 
perfectly performed, it may be found of service to supply 
the element, oxygen, by artificial means. This has been 
practiced successfully by isolated practitioners, though 
not always discriminately, perhaps, for a long time, and 
the profession generally are forming more favorable opin- 
ions of this resource, as medicine progresses. 

A few quotations from recent issues of the California 
Medical Journal will serve to illustrate: — 

"Dr. J. H. Kellogg found oxygen gas injected into the 
lower bowel to act promptly in converting the dark ve- 
nous blood of the portal capillaries into bright arterial 



Oli THE PRINCIPLES OF SELECTION. 

blood under vivisection, practised upon the guinea-pig 
and other lower animals. 

He also found that a patient presenting uremic symp- 
toms, viz., muddy skin, dingy sclerotics, coated tongue, 
brassy taste in the mouth, and persistent and distressing 
headache, while analysis disclosed an excessive amount 
of uric acid in the urine, improveed promptly upon the 
daily use of two liters of oxygen per rectum for three 
days. At this time the excess of uric acid had entirely 
disappeared from the urine. The same author reports fa- 
vorable results from this treatment in phthisis. 

"Grestwell treated nineteen severe cases of scarlatina 
with inhalations of oxygen gas, and the administration of 
oxygen water internally. The latter was taken gratefully 
by the patient, as it diminished the thirst and removed 
the nausea so often met with during the course of scarla- 
tinal nephritis. By carrying a larger quantity of fluid to 
the kidneys it aided these organs in the throwing off of 
the epithelia clogging up the tubules, and also in the ex- 
cretion of the specific virus. The inhalations were prac- 
ticed every two hours or every hour or half hour, accord- 
ing to the urgency of the case. About one-fourth of one 
cubic foot was inhaled at a sitting. In every case it re- 
moved the albuminuria. Convalescence was short and 
satisfactory. " 

"Rehn, of Frankfort, has made use of inhalation of oxy- 
gen in a number of cases. A girl of twenty-one years, who 
had been sick one year, and under good medical service, 
was suffering from what was diagnosed as leucaemia. She 
had total loss of appetite, great debility, and could not walk. 
The anaemia was of a high grade. She had enlargement of 
the spleen and liver; there was moderate oedema of the 
lower extremities. A microscopical examination of the 
blood showed a great increase in the number of white 
blood corpuscles. Inhalations of oxygen, fifteen liters 
daily, were ordered, and their use persisted in for one 



THE PRINCIPLES OF SELECTION. 53 

year, so that the girl is now as healthy as one could 
wish. " 

The peroxide of hydrogen may sometimes serve as a 
valuable medicament, for reason of the oxygen it contains. 
Even in threatened asphyxia in pulmonary congestion, 
this agent has been known to sustain life and ameliorate, 
meantime, a very unpleasant train of symptoms, until the 
severe local congestion had subsided, and the supply of 
oxygen could be obtained in sufficient quantity in tha 
natural way. 

THE PORTAL CIRCULATION. 

This portion of the sanguineous system is peculiar in 
its anatomy in that it consists of a double distribution of 
capillaries after leaving the arteries before entering the 
general venous circulation, and in its offices, that it re- 
ceives the food pabulum except what is absorbed by the 
lacteals, and exerts upon it the primary impressions 
which fit it for distribution by the general circulation as ' 
fuel and tissue-building material. 

The celiac axis and the superior and inferior mesen- 
teric arteries furnish the blood from the abdominal aorta, 
which is distributed to the stomach, pancreas, spleen, and 
intestines. The capillaries from this distribution to the 
alimentary canal serve as means of reception of the nutri- 
ment which has been put in condition by action of the di- 
gestive solvents, for ready absorption. 

These capillaries are gathered into venous channels 
which unite to form one large trunk, the portal vein, 
which enters the liver and distributes capillaries, these 
uniting within the hepatic organ with the capillaries of 
the hepatic artery, one of the branches of the celiac axis. 

The branches of the portal vein, hepatic artery, and bil- 
iary duct, keep company in their distribution through 
the liver, their capillaries forming vascular tufts of inti- 
mate association, the hepatic cells lying among the 



54 THE PRINCIPLES OP SELECTION. 

masses performing their important functions, the hepatic 
veins and their branches being common venous channels 
for the exit of the remodeled portal blood into the vena 
cava. 

"With normal activity of the hepatic cells, the secretion of 
bile goes on in such a manner as to conform with healthy 
processes. But with torpor of the biliary function, or 
obstruction to the free exit of the bile from the ducts 
after its secretion, this fluid finds its way through the 
capillaries of the hepatic vein into the general circulation, 
and symptoms of jaundice appear. 

"Bile, as such, is not pre-formed in the blood. It is 
formed by the hepatic cells, although some of the mate- 
rial may be brought to them almost in condition for imme- 
diate secretion. When it is, however, prevented by an 
obstruction of some kind from escaping into the intes- 
tines (as by the passage of a gall-stone along the hepatic 
duct), it is absorbed in great excess into the blood, and 
circulating with it, gives rise to the well-known phenom- 
ena of jaundice. This is explained by the fact that the 
pressure of secretion in the ducts is very low, and if it ex- 
ceed three-fifths inch of mercury the secretion ceases to 
be poured out, and if the opposing force be increased, the 
bile finds its way out into the blood. " — Kirke. 

Evidently the principles of selection demand discrimi- 
nation in the matter of the bile-secreting function, if we 
are to expect success to follow our efforts for relieving 
different cases of jaundice. It is not enough to prescribe 
a remedy here possessing an affinity for the liver. The 
remedy must exert an influence to correspond with the 
part effected. The sluggishly operating biliary process 
may be encouraged, in the absence of obstruction, by chi- 
onanthus, or a similarly acting remedy, but if obstruction 
exists, the character of the lesion must be determined and 
rationally prescribed for. Obstruction by gall-stones, in 



THE PEINCIPLES OF SELECTION. 55 

the absence of more specific means, may be relieved by- 
olive oil, but if tumefaction of the lining membrane 
of the biliary ducts from catarrhal inflammation be pres- 
ent, cheledonium will be a more appropriate remedy; or 
if the obstruction be due to pressure from general conges- 
tion of the abdominal blood-vessels, we will expect ben- 
efit from polymnia, ceanothus, carduus, or grindelia squar- 
rosa ; or nux or podophyllin, if the fault be due to fullness 
of the hepatic capillaries. 

Cholagogues deserve no consideration in a work on dy- 
namical therapeutics ; agents which stimulate the flow of 
bile appreciably, must act as disturbers, not only of the 
biliary function, but of every associated process. Eesto- 
ration of the bile-secreting function, can be brought about 
more satisfactorily and permanently by agents not so 
liable to disturb the general functional relationship pre- 
vailing. 

The glycogenic function of the liver is an important 
one, serious consequences being the result of its perma- 
nent disarrangement. 

The glucose formed from the saccharine and amyla- 
ceous portions of the food is converted into glycogen, or 
liver starch, and stored away in the substance of the 
gland as a means of supply for the needs of the body when 
sugar is demanded; this is reconverted into glucose by 
the hepatic functions when required. Disturbance of 
this function interferes with such elaboration, and permits 
the raw product from the portal vein to traverse the he- 
patic circulation without change, to serve as an irritating 
element in the general circulation, or else the transforma- 
tion by the liver goes on at an excessive rate, and the 
lungs, which sustain a certain relationship by the com- 
bustion of sugar in the pulmonary circulation, as well as 
the kidneys, upon which devolve the duty of removing the 
excess, must suffer. 



56 THE PRINCIPLES OF SELECTION. 

Therapeutically, we are at a loss to know whether rem- 
edies relieve such disturbance through specific influence 
upon the liver, upon the vaso-motar centers of the organ, 
or through their influence upon the respiratory centers by 
encouraging the combustion of sugar in the pulmonary cir- 
culation. But we know, empirically, that syzygium re- 
lieves such disturbance in some cases, at least, and less- 
ens the amount of sugar present in diabetic urine. 
Probably to effect a cure its use must be begun early, 
but the success already met with will encourage the be- 
lief that diabetes may yet be classed among the cur- 
able complaints, and thus stimulate further research. 

Nitrate of uranium has been accredited with the cure 
of numerous cases of diabetes mellitus by physicians of 
our own school, as well as those of homeopathic and allo- 
pathic persuasion, and we should not forget two so impor- 
tant remedies as this and syzygium when the glycogenic 
function of the liver is at fault. 

The action of the liver upon the products of albuminous 
food conveyed to it by the portal vein is a function of the 
greatest importance. The peptones of the portal blood 
must be submitted to the action of the liver cells before 
their presence can be tolerated in the general circulation. 
It has been found that such matter injected into the jugu- 
lar vein speedily appears in the urine, demonstrating its 
rejection as blood or tissue-making pabulum unless the 
liver has exerted an influence upon it. 

Excessive indulgence in lean meats is usually the cause 
of disarrangement of this function, and knowledge of the 
cause would suggest an important element of cure, — avoid- 
ance of animal food. 

But the tired liver may be invigorated in this case by 
the proper remedy, the effects being observable, not so 
much perhaps in local changes, as in the sense of relief 
experienced in the system generally. 



THE PBINCIPLES OF SELECTION. 57 

In such a case the symtoms of general prostration are 
out of all proportion to the real amount of disease pres- 
ent. The patient is tired, so that the least exertion is 
dreaded, often drowsy, inclined to lethargic sleep in the 
day-time, while restless wakefullness harasses his mid- 
night hours. The appetite meanwhile is often unnatu- 
rally voracious. 

Abstinence from animal food and a spare diet generally, 
will assist therapeutic application here. The specific 
remedy is mercurius dulcis in the second or third decimal 
trituration, in small doses, three or four times daily. 
Nothing more magical was ever known in medicine than 
the effect of this remedy, properly adapted. The value 
of the hepatic influence of hydrochloric acid has long 
been recognized ; in small doses, well diluted, it serves a 
valuable purpose here. 

The uric acid habit — lithaemia, as well, probably, as oxa- 
luria — is referable to imperfect hepatic action upon certain 
elements of the portal blood; though without doubt the 
primary fault is lack of thorough oxidation of the nitrog- 
enous elements of the tissues undergoing retrograde met- 
amorphosis, in addition to faulty material which has 
passed the portal circulation without receiving due elab- 
oration. 

If one of the functions of the portal circulation is the 
conversion of waste proteid material into urea, it is im- 
portant in all cases of chronic disease to inquire into the 
amount of work being thrown on this part. The habitual 
presence of excess of lithic acid in the urine indicates 
faulty action here, and demands that a better preparation 
of the general current distributed to the portal circulation 
shall be made. 

Liquor potassae, benzoic acid, and benzoate of ammonia, 
may then become, indirectly, important remedies for dis- 
turbed states of this circulation by aiding the kidneys to 



58 THE PRINCIPLES OF SELECTION. 

carry off an excess of an element which taxes the powers 
of the structures among the hepatic capillaries. Oxygen 
administered in different ways may also be of highest serv- 
ice in assisting in a more complete conversion of proteid 
products into normal excrementitious material. 

BLOOD PRESSURE — ARTERIAL TENSION. 

"The arteries in the normal condition are continually on 
the stretch during life, and in consequence of the injection 
of more blood at each systole of the ventricle into the 
elastic aorta, this stretched condition is exaggerated each 
time the ventricle empties itself. The condition of the 
arteries is due to the pressure of blood within them, be- 
cause of the resistance presented by the smaller arteries 
and capillaries (peripheral resistance) to the emptying of 
the arterial system in the intervals between the contrac- 
tions of the ventricle, and is called the condition of arterial 
tension. " — Kirke. 

It has been estimated that the arterial tension in the 
aorta of the human adult is equal to about four and one- 
fourth pounds avoirdupois. As the distance from the 
heart increases there is a corresponding decrease in the 
pressure, the tension in the radial artery, for instance, at 
the wrist being only about four drachms. Thus the blood 
pressure is greatest in the left ventricle and decreases to- 
wards the capillaries. In the capillaries, arterial tension 
ceases to be the principle motor, though it probably 
serves as a vis a tergo in forwarding the blood on its 
rounds, though the attraction of the various elements for 
the tissues is here undoubtedly more of a motor force. 

A relative compensation between arterial tension and 
vascular integrity, is essential to the continuation of 
health and life. A common cause of disease and sudden 
death is rupture of an artery through undue intravascu- 
lar pressure. Certain conditions conspire to a large 
amount of blood in the vascular system; here the strain is 



THE PBINCIPLES OF SELECTION. 59 

principally upon the arteries, as the capacity of both cap- 
illaries and venous system greatly exceeds that of these 
vessels. 

Certain individuals incline to plethora — fullness of 
blood, and the arterial tension may be so great that the 
strain finally ruptures an artery in some unfortified sit- 
uation, as in the delicate structures of the brain, for in- 
stance, and sudden death or a confirmed hemiplegia is 
the result. 

Age is one of the predisposing causes of this condition, 
degeneration of the arterial coats often being one of the 
results of senility; but certain climates may predispose 
to such accidents, in persons of middle and even early 
life. 

On the Pacific Coast, we find deaths from arterial rup- 
ture — as well as hemiplegia — of quite frequent occurrence, 
among persons who have not reached the period of bodily 
decay, and the causation must be attributed more to un- 
due arterial tension, usually, than to lack of integrity upon 
the part of the tissues of the arterial walls. 

Plethora is due here, probably, to our climatic pecul- 
iarities. The dampness of the atmosphere reduces the 
surface evaporation to a minimun quantity, and the cool ? 
bracing air stimulates indulgence in a liberal diet ; conse- 
quently the blood is freely supplied with pabulum and the 
nutritious elements are rapidly manufactured into body 
fluids until the vascular system is filled to repletion. 
Fulless of tissue, — plumpness of form — of the average 
inhabitant of the Pacific Coast is a subject of common 
remark, and a no less noticeable peculiarity, to the medi- 
cal observer, is the frequent occurrence of apoplexy. 

Probably, also, we may justly ascribe many of our com- 
mon nervous diseases, as insanity and insomnia, to this 
cause, — vascular pressure in the cerebral arteries, con- 
tinued for a long time, finally giving rise to pronounced 



60 THE PRINCIPLES OF SELECTION. 

functional disturbance, as manifested by trie irritabil- 
ity of abnormal wakefulness, or that of mental aberration. 

And we may observe other disturbances, due, without 
doubt, to this influence. Chronic congestive conditions — 
as well as acute — are more aggravated, painful, and stub- 
born, where there is excessive arterial tension; and thera- 
peutic measures may be materially assisted by temporary 
removal from the influences which encourage it, into sur- 
roundings which tend to neutralize such a state. 

In such climate as that of Arizona, where the air is 
dry and warm, and surface evaporation quickly robs the 
blood-vessels of their superfluous fluids, spareness of 
form is the tendency. Dr. Munk asserts that the climate 
of that country is a positive anti-fat remedy; probably 
this is so because the physical conditions tend to rapid 
removal of the fluids of the body. Here we would expect 
arterial tension to be at a minimum and apoplectic affec- 
tions of rare occurrence. 

But there are sections nearer at hand than Arizona 
which offer nearly as favorable advantages for the purpose 
desired. The interior of California affords many places 
which may supply everything necessary, in a warm, dry 
atmosphere. 

On the other hand, lack of arterial tension may give 
rise to anaemic conditions which ought to be benefited by 
removal into such a climate as that of our coast. Here 
the natural advantages encourage blood-making, increase 
arterial tension and the supply of nutritious fluids to 
every part of the body, and thus afford the very means to 
successfully abet the efforts of medicine in accomplishing 
restoration. 

The therapeutics of arterial tension may consist of 
evacuants, by which the superfluous fluids are removed 
from the body, through the skin and kidneys. Latter- 
day therapeutists might suggest nitrite of amyl, nitro- 



THE PKLNCIPLES OF SELECTION. 61 

glycerine, and other depresso-motors here, but it is not 
probable that any remedy can long counteract the con- 
stant influence of climatic tendencies. 

A change of climate, for a time, may serve a better 
purpose. Persons of plethoric habit or other apoplectic 
tendency would do well to abide in a region where the nat- 
ural surroundings contribute to free cutaneous and pul- 
monary evaporation, as this must act as a safety-valve in 
relieving undue arterial tension, by lessening the propor- 
tion of circulating fluids. 

Venesection here, severely as it has been denounced by 
Eclectics, would not seem so irrational after all, when an 
apoplectic seizure indicated arterial rupture, with possi- 
bility of extension of the lesion ; true, the best portion of 
the blood may be abstracted, but in such patients, usually, 
the manufacture of new material would seem to be one of 
the most readily accomplished functions. 

THE PULSE. 

The pulse affords an index to the selection of remedies 
in quite a wide range of acute diseases. In chronic ail- 
ments, also, it should be taken into consideration in mak- 
ing up the general estimate of therapeutic indications. 

The condition of the heart may be pretty well de- 
termined by the practiced touch, from the pulse, but as 
auscultation is a more accurate method of detecting cardiac 
alterations, examination of the radial impulse is not so im- 
portant here, as in estimating the state of the vaso-motor 
centers, the general tone of the circulatory system, the 
freedom from, or presence of, obstruction to the vascular 
stream, and character of impression made by the disturb- 
ing element, upon the general nervous system. 

Arbitrary propositions have been found more satis- 
factory than the most labored deductions in adapting 
remedies to the various conditions of the circulation as 
indicated by the pulse ; for example : — 



62 THE PRINCIPLES OF SELECTION. 

The rapid bounding pulse denotes arterial relaxation 
from temporary suspension of force in the vaso-motor 
centers, and is usually present in sthenic conditions, the 
disturbing cause having been but recently developed. It 
either subsides to the normal condition within a limited 
period, or merges, in continued febrile states, into a more 
feeble impulse, indicating debility. Gelseminum is the 
specific remedy here. 

The rapid, hard pulse denotes sthenia with obstruction 
to some important avenue in the circulation, as of the 
pulmonary vessels, the obstruction being probably inflam- 
matory in character. Here jaborandi or veratrum are 
especially indicated. 

The full, hard pulse with dry skin, and severe localized 
pain, is an indication for jaborandi, in full doses. 

The rapid, small pulse indicates excitation of the vaso- 
motor centers without corresponding reactive power on 
the part of the heart and blood-vessels. It is the pulse 
of asthenic fevers and inflammatory conditions in subjects 
lacking robustitude. Aconite is the leading specific rem- 
edy here, if the dose be not too large. 

The rapid, small pulse, with erratic, shifting pain, calls 
for antipyrin, in moderate doses. 

The feeble, compressible pulse, with coldness of the ex- 
tremities, dizziness, and pallor of the skin, denotes feeble 
capillary circulation, and the need of belladonna or capsi- 
cum. There may, or may not, be dilatation of the pupils. 

The rapid, wiry pulse denotes unusual disturbance of the 
cerebro-spinal capillaries, and is often marked by rest- 
lessness and delirium, with bright eyes and contracted 
pupils. Here rhus tox. is the appropriate remedy. 

The excessively rapid, fluttering pulse indicates a tremu- 
lous heart action, with impending paralysis of the cardiac 
ganglia. It occurs in febrile conditions of the aged, and 
from the markedly prostrating effects of such poisons as 



THE PKINCIPLES OP SELECTION. 63 

those of diphtheria and scarlatina. Lachesis is the rem- 
edy for such indications. 

The feeble, labored pulse, with sighing respiration, indi- 
cates heart failure and demands nitro-glycerine. 

When the pulse denotes a chronically feeble heart 
action, such agents as cereus Bonplandii, digitalis, and 
strophanthus, should be thought of; but this leads us to 
the consideration of cardiac therapeutics, which had best 
be examined separately. 

Some writers enter into still further detail, in respect 
to therapeutic indications furnished by the pulse, but too 
much detail would be liable to impair the usefulness of 
this valuable diagnostic resource. 

An old school writer, Dr. W. E. Lowman ( Medical Bul- 
letin) offers the following, on pulse indications of patho- 
logical conditions : — 

"Study pulse carefully. May range normally from 50 
to 100. Male usually 72 per minute; female, 76. In- 
crease per 1° rise temp., 10 beats per minute. The pulse 
may be quick i n stroke yet in beats slow or infrequent; 
full, round, and large; empty, small, or thread-like; strong 
or weak in impulse ; hard, whip-cord, or soft, compress- 
ibl e; wiry, like wire striking the finger ; irregular, fast and 
slow alternately; intermittent, one or more beats lost ; di- 
crotic, double-stroked; asynchronous. 

"Normal pulse in sphygmographic curves. 

"Full and strong inflammatory fevers and hypertrophy 
of heart. 

" Slow, hard, and strong, pulse of laborer, boxer, etc. 

" Slow, strained, and strong pulse of meningeal derange- 
ment, but not a sign in the powerful. 

"Frequent in pregnancy. 

"Slow few hours after labor. 

"Weak and slow in dilatation of heart. 

"Very frequent in some specific fevers; sometimes from 



64 THE PRINCIPLES OF SELECTION. 

weakness, as in diphtheria, therefore stimulants will often 
bring down. 

"Quick and sometimes hard and sharp in abdominal or 
rheumatic inflammation. 

"Frequent, hard, sharp, and wiry in gastric or inflam- 
mation of any organ below the diaphragm. 

"Small, soft, and quick in aortic stenosis or dilatation 
of veins. 

" Small and slow, extreme debility. 

"Irregular, and often quick, later stages pericarditis. 

"Irregular, often only sign of endocarditis. 

"Intermittent, angina pectoris, cardiac, and brain dis- 
eases, but sometimes normal. 

"Dicrotic, grave, approaching dissolution. 

" Small and irregular, mitral affections. 

"High and fast, aortic insufficiency. 

"Tardy, senile. 

"Asynchronous pulses from asynchronous contraction 
of sides of heart, double sound, but no double wave for 
each, symmetrical. Unilateral is diagnostic of aneurism. " 

THE TEMPERATURE. 

The temperature of the body is an important considera- 
tion in questions of health and disease. So nicely are the 
compensating forces of the organism balanced that it is 
impossible for a marked departure from the normal stand- 
ard of 98.6° Fahr. to occur without serious disturbance of 
the vital processes resulting. 

In earlier time the temperature was estimated roughly 
from the impression conveyed to the touch of the observer 
by the heat of the surface, but this estimate was of little 
value in determining the significance of an elevated or de- 
pressed temperature, and it failed entirely in enabling 
the observer to arrive at any data of reliability. Now the 
exact temperature is ascertained by an instrument which 
leaves all guess-work out of the question and enables one 



THE PRINCIPLES OF SELECTION. 05 

to form a very intelligent idea of the character and prob- 
able results of the condition, in many diseased states. 

In most cases of disease if the thermometer indicates 
any departure from the normal temperature it will be in 
an upward direction. Even though the surface or extrem- 
ities may seem cold to the patient and observer, and in 
fact may be below normal heat, owing to absence of the 
usual amount of blood in the superficial capillaries, the 
thermometer may register two or three degree's elevation 
in the cavities where the blood is circulating more freely. 
Sometimes, however, during a chill, thermometry has dem- 
onstrated beyond cavil a lowering of the normal temper- 
ature in the cavities usually tested. Whether the actual 
temperature of the blood is lowered may nevertheless be 
considered a question, as the internal organs may even 
then be subject to an increased caloric. During convales- 
cence from continued fevers or other protracted illness 
the temperature may be slightly depressed for some time, 
until the debilitated vital forces recover wonted vigor. 

In febrile states there may usually be a rough estimate 
made between the elevation in degrees of temperature 
above normal and in the increased frequency of the pulse^ 
each degree of elevation corresponding to ten pulse-beats 
per minute. For example, with the normal pulse at sixty- 
five per minute, we would expect the temperature to be 
99.6° if the pulse rate were seventy-five, 100.6° at eighty- 
five, 101.6° at ninety-five, and so on. This, however, is not 
a rule to be depended upon, as the nervous susceptibili- 
ties of patients 'vary so much that an excited heart-beat 
might result from slight provoking causes in one, while in 
another the same amount of disturbance would hardly be 
appreciated. Still it is a proposition not to be disputed 
that increase of temperature is attended by increased ac- 
tion of the heart; in fact, the accelerated circulation with 
increased oxidation of tissue may be fairly regarded as 



$6 THE PRINCIPLES OF SELECTION. 

the cause of the elevated temperature, the excited 
circulation being the result of irritation of the sympa- 
thetic nerve centers, from which spring the regulating 
fibers of the circulatory apparatus. 

An elevation of the temperature above the normal 
standard, indicates an abnormal rapidity in the oxidizing 
processes in the tissues — a condition that must be attended 
by wasting of flesh and loss of strength, the danger of 
final exhaustion being in proportion to the amount of ele- 
vation and persistence of the condition; a remitting, ele- 
vated temperature is not so dangerous as a constant one 
as during the remissions the vital powers are somewhat 
recuperated. 

Means which lower the temperature rapidly are not us- 
ually desirable, as they must prove depressing to the 
entire vital forces. Those which act mildly and bring 
about a slowing of the oxidizing processes gradually are 
to be preferred, usually, for they leave behind a salutary 
condition of the general system. The special sedatives, 
therefore, are the most desirable means of accomplishing 
this purpose, for as there seems an intimate relationship 
beween bodily temperature and pulse rate, when abnormal 
elevation occurs, a moderation of the excitement of the 
circulation promises a lowering of the heat. 

But there are other means which sometimes seem to act 
better than the sedatives. In typhoid conditions where 
septic states of the blood prevail, the sedatives seem 
sometimes to have lost their power of impressing the vaso- 
motor centers, and we find it necessary to resort to more 
heroic means and, perhaps, more empirical ones. Some- 
times the hot pack properly applied succeeds here admira- 
bly in reducing a temperature of 107° or more Fahr. to 
nearly the normal rate, and thus in a short time almost 
aborts a disease which might otherwise prove fatal. 

Dr. Lyman Watkins (California Medical Journal) reports 



THE PEINCIPLES OF SELECTION. 67 

sucess in a severe and fatal endemic of typhoid fever 
from trie use of heroic doses of quinine — 30 to 40 grains 
at a time, or within a few hours, lowering a temperature 
as high, in some cases, as 107° to near the normal rate, in 
a short time. This treatment was found superior to the 
use of the special sedatives, no mortality following after 
the use of the large doses of quinine was begun. 

A. knowledge of the state of the temperature is some- 
times important, that the proper time may be selected for 
the exhibition of remedies. In a remittent fever if the 
remission be short and we desire to make avail of it for 
the administration of an anti-periodic, we may learn when 
it has begun by the thermometer before the ordinary 
symptoms may be detected. In typhoid fever, scarlatina, 
and other fevers, where powerful agents are employed to 
depress the temperature, — and the exhibition of such 
means may sometimes be all-important, the thermometer 
enables us to tell just when the temperature has arrived 
at that point where the remedy must be discontinued for 
fear of too great depression ; large doses of quinine, anti- 
pyrin, jaborandi, and kindred agents should not be ad- 
ministered without the guidance of clinical thermometry 
to point out the time for discontinuance, lest the depres- 
sion of temperature be carried beyond the period of recu- 
peration. 

Knowledge of a depressed state of temperature would 
prompt the application of artificial heat, and the internal 
use of such agents as capsicum, myrrh, and possibly 
brandy and ether; where the depression was more chronic 
in character, Faradism, massage, pure air, and other hy- 
gienic measures should take the place of artificial stimu- 
lants. Protracted depression due to capillary congestion 
requires the specific agent, belladonna. 

THE ALIMENTARY CANAL. 

The functions of the alimentary canal, though somewhat 



68 THE PRINCIPLES OF SELECTION. 

complicated, look to tlie one end — the supplying of nutri- 
ment in absorbable condition, to the blood-vessels and 
lacteals. 

The complication of function, however, is due to the 
character of food required — the variety of substances de- 
manding numerous solvents and digestive cavities for their 
complete preparation for appropriation. In the mouth, 
the masticatory process is supplemented by the action of 
the saliva which, in addition to the specific property of 
converting starch into sugar, acts as a mechanical element 
in lubricating the bolus for ready passage along the 
oesophagus during the act of deglutition. 

The oesophagus serves as a conduit to the stomach, 
where digestive proceedings assume a new phase, the 
mucous membrane of this cavity providing a fluid of acid 
reaction for the solution, exclusively, of albuminous food 
(proteids). 

Passing the pyloric orifice and entering the duodenum 
the aliment becomes subjected to a variety of digestive 
solvents, which, however, combined, afford an alkaline re- 
action. Here the digestion of starch and albumen already 
begun in mouth and stomach is furthered to completion, 
and in addition the fats thus far unaffected are broken 
up so minutely as to be prepared for reception by the ab- 
sorbents of the lacteals. 

Here all the digestive solvents are combined, — saliva, 
gastric juice, pancreatic secretion, bile and intestinal 
fluid, — to carry out the complete preparation of the 
aliment for reception by the portal capillaries and 
lacteal absorbents. 

But the requirements of good digestion do not end 
here. A free circulation in the abdominal blood-vessels 
is essential to a proper elaboration of the digestive juices. 
Secretion cannot go on well if the vessels which furnish 
the elements are in a disturbed state. The proportion of 



THE PEINCIPLES OF SELECTION. 69 

aliment requisite to the needs of the economy must be 
appropriate, for if in excess, the hepatic functions become 
affected, and a backward influence is exerted upon the ab- 
dominal capillaries to disturb, not only the separation of 
the digestive solvents, but, likely, even the normal peristal- 
tic action. The debris of ingested food must be moved 
along and evacuated in order to preserve the proper rela- 
tions and equilibrium between all the functions of diges- 
tion. 

Impaction of the lower bowel is a common and power- 
ful factor in disturbance of the alimentary functions, — a 
condition commonly recognized but most irrationally 
treated. The sympathy of all parts of the alimentary 
canal for each other, accounts for many cases of indiges- 
tion, mal-nutrition, and reflected nervous ailments arising 
from impaction of this passage, below the point where 
the active processes of digestion cease. A habitually 
impacted colon may thus become the cause of a thou- 
sand sympathetic and reflected ills, of which indigestion 
and neurosis constitute the principal symptoms. 

Eectal diseases, then, and torpid states of the lower 
bowel, present claims of fully as great import in the man- 
agement of alimentary disturbances as the therapeutics of 
the upper portion of the canal. Possibly medicine may 
be the only requirement here, but judiciously adapted 
surgical knowledge is important, that a proper preserva- 
tion of the alimentary functions may be accomplished. 

The physician must not forget the bearing which age 
exerts upon the functions of digestion. Nature provides 
the infant with only the capacity of digesting animal food, 
the salivary glands and pancreas lack the power of con- 
verting starch into sugar, and this substance when taken 
by such subject undergoes only those changes which tend 
to produce disturbance of digestive action. The lesson 
should prompt the rejection of such foods as a primary 



70 THE PKINCIPLES OF SELECTION. 

measure, if remedies are to be expected to bring about a 
desired result, when infantile intestinal affections are pre- 
scribed for. 

In advanced life the general atrophy which affects 
the individual extends to the walls of the alimentary 
canal, as well, and a dietary entailing as little muscu- 
lar and glandular effort upon the part of the structures 
here as possible should be provided, if the full effect of 
therapeutic agents is to be expected. 

The common plan of medicating the alimentary canal 
presents many pernicious features. Cathartics to relieve 
constipation, astringents to arrest diarrhea, preparations 
of pepsin and pancreatin for indigestion, bismuth, per- 
haps, for irritated states of the gastro-intestinal mucous 
membrane, and opiates for pain, when this is a feature, 
comprise the bulk of treatment prescribed by the ordi- 
nary practitioner. 

Cathartics unload the lower bowel, but in doing so they 
disturb, more or less, the important functions carried on 
in the stomach and small intestine, and they furthermore, 
when habitually employed, predispose the mucous mem- 
brane to indurations and epithelial changes which not un- 
frequently terminate in cancerous growth. 

Astringents are rarely of value in gastro-intestinal af- 
fections; they may occasionally afford satisfaction in the 
treatment of watery evacuations from the bowels, but usu- 
ally the intestinal capillaries can be more promptly in- 
fluenced by agents which specifically impress them in 
dynamical doses. 

The practice of supplementing the action of the 
glandular structures which secrete the digestive ferments 
with artificial supply, lacks reason. To lapse into use- 
lessness is not the part that any portion of the body 
can be expected to take. The pepsin delusion has many 
followers ; possibly exceptional cases are benefited by 



THE PRINCIPLES OF SELECTION. 71 

its administration, but as many are aggravated as are 
bettered. Indigestion cannot be favored materially by 
the artificial supplying of digestive ferments when the 
apparatus which ought to secrete them is in an abnormal 
condition. 

Pepsin and kindred preparations, when genuine as to 
quality, may aggravate gastro-intestinal difficulties — 
though doubtless they sometimes prove beneficial — while 
often the negative results obtained depend upon the com- 
plete worthlessness of the preparation; an infusion of ren- 
net is more reliable than the majority of pepsin products 
offered in the market. 

Dynamical therapeutics, as applied to the alimentary 
canal, may be separated into three divisions: (1) The thera- 
peutics of diet; (2) the therapeutics of the sanguineous cir- 
culation of the part ; and (3) those agents which specific- 
ally influence special portions of the track through tissue 
affinity. 

The therapeutics of diet is a subject of such importance 
as to demand a separate and careful study, and will only 
be referred to here. 

The therapeutics of the circulation demand considera- 
tion of two classes of remedies; those which influence 
the general circulation — for the parts above the stomach 
are supplied from this source — and those which are espe- 
cially adapted to the portal system. This subject, which 
has already been studied, demands further investigation; 
for when its possibilities are completely understood we 
will have brought the problem of derangements of the ali- 
mentary canal much nearer solution. 

The third class of therapeutics here is that which in- 
cludes those agents which by their tissue affinity specific- 
ally influence different portions of the apparatus; for 
instance, beginning with the mouth, we have iris, jabo- 
randi, phytolacca, and mercurius, for the mucous membrane 



72 THE PRINCIPLES OF SELECTION. 

and salivary glands; penthoruni and Phytolacca, for the 
pharynx; lachesis, naja, veratram, etc., for the oesoph- 
agus ; arsenic, boldo, lobelia, mix vomica, potassium 
bichromate, and many others, for the stomach; colocynth, 
epilobium, ipecac, baptisia, etc., for the small intestine; 
iris versicolor, iodine, and mercurius, for the pancreas; po- 
tassium bichromate, mercurius corrosivus, and others, for 
the colon; and aesculus, collinsonia, etc., for the rectum. 
These specifically influence their respective portions, 
improving nutrition, encouraging normal secretion, mus- 
cular power, and recuperative energy, when disease is 
present, relieving irritation, and thus conducing to 
healthy conditions. 

In addition to such agents, properly selected, local in- 
fluences may often be of service, and the subnitrate of 
bismuth especially may prove of signal value for its 
soothing effect on the gastro-intestinal mucous membrane. 
In the absence of proper digestive power the prepared 
foods are preferable to pepsin or other digestive ferments, 
as such debility is hardly ever confined to the peptic or 
pancreatic glands alone, but is shared by other parts 
whose integrity of structure and action is equally im- 
portant. 

Proper operative procedures are also of prime impor- 
tance in the management of many cases of alimentary 
derangement. An irritable sphincter may counter-balance 
all the advantage to be derived from medicines, and may 
require surgical interference, in order to relieve the 
troublesome reflexes arising, before the expected thera- 
peutic effect can follow. 

Fecal impaction, so sure to result from this condition, 
may require this as well, and the procedure may need be 
supplemented by the use of galvanism, in order to arouse 
a part long subject to torpor, to normal activity, and in- 
sure the regular movement so essential to health. 



THE PRINCIPLES OF SELECTION. 73 

Rectal diseases thus constitute an important branch of 
practical medicine, and demand the careful consideration, 
not of the specialist alone, but of the general practitioner, 
if he is to be successful in his calling. 

THE TONGUE. 

The tongue serves as a valuable guide in the selection 
of a number of remedies, which could hardly be dispensed 
with in the treatment of disease. 

Being a portion of the digestive tract, it seems to pos- 
sess, in its shape, color, and other appearances, in many 
instances, an index of the condition of the stomach and its 
associate viscera. The circulation here, its character, the 
condition of the blood, as well as the state of the nerv- 
ous supply, may often be tolerably well determined by in- 
spection of the tongue, and the appropriate remedy also 
selected. 

Thus, torpid conditions of the stomach, liver, and asso- 
ciate organs concerned in digestion, are reflected by the 
tongue, which is full, broad, and flabby, and is protruded 
slowly and awkwardly. Morbid accumulation in the 
stomach associated with this condition is manifested by a 
deposit upon the base of the organ. Irritation of the 
gastro-intestinal surfaces is manifested by a narrow, 
pointed tongue, the tip of which is usually reddened; 
with this condition is often associated tremulousness 
upon protrusion, indicating a high state of nervous ten- 
sion. 

The condition of the blood as regards tendency to 
zymotic changes, is also most readily indicated by the 
tongue, the pallid mucous membrane and white coating in- 
dicating excessive acidity of the alimentary canal and lack 
of soda salts in the plasma; this can be demonstrated by 
testing with litmus paper. On the other hand, the oppo- 
site condition — lack of acids in the alimentary canal, and 
probably excess of the salts of sodium in the blood- — is 



74 THE PEINCIPLES OF SELECTION. 

indicated by abnormally dark red color of the mucous 
membrane. This indication, however, must not be con- 
founded with the bluish or purplish discoloration con- 
sequent upon a cyanotic state ; here the means best 
adapted to the furthering of oxygenation of the blood 
should be selected, as most appropriate. 

The coating which appears on the tongue — sometimes 
in health as well as in disease — has been shown by Dr. 
W. H. Dickinson, through microscopical examination, in 
a large number of cases of both healthy and diseased 
subjects, to consist of horny epithelium, and the various 
grades of accumulation to consist in its increase. Inci- 
dentally connected with this, may be found certain para- 
sites, though their presence might exist in a state of 
health. 

"Want of attrition, as in abstinence from food, may 
favor such accumulation when disease is present, but it 
seems indisputable that it often depends upon deprava- 
tion of the fluids usually febrile or inflammatory in char- 
acter. 

The dry tongue may be the result of the passage of air 
over the surface of the organ, as when one sleeps with 
the mouth open, or it may result from the use of opiates 
which temporarily arrest the secretion of the salivary 
glands, but when persistent the symptom is due to want 
of salivary secretion from constitutional disturbance; 
though then the patient is liable to aggravate the condi- 
tion by mouth breathing. 

In diabetes and diarrhea, however, dehydration of the 
blood to an abnormal extent may account for a dryness 
of the tongue. In a peculiarly dry atmosphere that will 
favor rapid evaporation, the symptom may be common to 
diseases of mild type. In a moist climate, as of the 
Pacific Coast, the dry tongue is Dot a common symptom; 
even in serious forms of disease where great prostration 



THE PRINCIPLES OF SELECTION. 75 

is present, it is remarkably rare, as compared with less 
humid sections. 

As a rule, the dry tongue, under other circumstances 
than those already referred to, may be considered as an 
indication of marked prostration. "When the tongue is 
dry and bare," says Dickinson, "it is ill with the patient. 
He is not sure to die but likely to. If, as has been said, 
the tongues of dying men enforce attention, it must be 
often directed to this. " 

The coating of a dry tongue must sooner or later be- 
come brown and exfoliate, leaving the organ bare and 
slick. It is a process of denudation certain to follow 
from death of the epithelial covering consequent upon in- 
ability of the lingual capillaries to transmit nutrition to 
the desiccated epithelium, and destruction and separation 
must follow. 

The application of remedies to conditions of disease, as 
indicated by the tongue, has been learned by empirical 
practice — by the plan of " cut and try, " usually adopted 
when no well-defined method or principle of procedure 
is obvious. Such knowledge, however, is as valuable as 
any other, when proven, and considerable assistance in 
prescribing can be drawn from indications thus deter- 
mined. For example : — 

The broad, flabby tongue, with heavily coated base, 
accompanied by gaseous eructations and sense of heavi- 
ness in the epigastric region, indicates the need of an 
emetic. 

The broad, flabby tongue, with pallid mucous membrane 
and white coating, indicates the need of a salt of sodium, 
the sulphite usually being preferable. This is pre-emi- 
nently the remedy, if the coating be plastered — pasty — in 
appearance. The pallidity of anaemia should not be con- 
founded with that of this condition. 

The dark-red, slick tongue — resembling beef steak — 



76 THE PRINCIPLES OF SELECTION. 

indicates the need of hydrochloric acid; though other 
forms may answer, lemonade, lime-juice, and similar acids, 
being more acceptable and nearly as efficacious, in many 
instances. 

The abnormally dark red tongue with dirty, brown coat- 
ing indicates the need of sulphurous acid. When the 
brown covering is well-defined, and not due to staining 
by food or medicines — as may result from fruits, iron, 
etc. — this remedy will be found reliable in the absence 
of increased redness of the mucous membrane. The sul- 
phurous acid tongue, when marked, is often associated 
with sordes on the teeth and lips. 

The narrow, elongated, 'pointed tongue, with reddened 
tip and edges, indicates gastric irritation, and is usually 
attended by nausea and vomiting. When protruded 
tremulously, it calls for rhus tox ; otherwise, ipecac, sub- 
nitrate of bismuth ; or an infusion of the bark of the 
amygdalus persica (peach tree) may be preferable. 

Prominence of the fungiform papilla? at the tip and 
edges gives us the "strawberry tongue" usually also nar- 
row and elongated. This is generally observed in febrile 
conditions, being common in scarlatina, and not rare in 
some forms of continued fever. Rhus tox. affords satis- 
faction as a remedy in the majority of such cases. 

The contracted tongue — short and narrow — with dry, 
shriveled center, denotes blood depravation, with pro- 
found vital prostration. It indicates the need of rhus 
tox., echinacea, or, if the case be typhoid fever, baptisia; 
if attended by convulsive tremors of the extremities — 
s-ubsultus tendinum, potassium phos. 

A noteworthy condition of the tongue is that which has 
been described as the "map" tongue, by some writers. 
The appearance of the organ is striking, but presents lit- 
tle therapeutic significance, as the condition is probably 
local, or at least of the character of a cutaneous eruption, 



THE PRINCIPLES OF SELECTION. 77 

depending perhaps upon some disturbance of the trophic 
nervous supply. 

Many of these indications have been taught by Scud- 
der, and have been employed by physicians of our school, 
with the happiest results, for years. Other indications 
have been proposed, but I believe this is a subject 
which can be carried into so trifling detail as to be ren- 
dered embarrassing, and thus interfere with the real worth 
of such means of therapeutic adaptation. When we at- 
tempt too much, where there is so little opportunity of 
marked changes as the tongue affords, we must deal with 
whimsical symptoms which mean little or nothing, and 
are not seen alike by two observers. 

But these are so plain that none will mistake them, and 
they cover about all the ground the subject will allow. 
When they are manifest, there is no uncertainty about 
the plan to pursue; with the tongue indication marked, 
the appropriate remedy should constitute the foundation 
of the treatment until a normal condition, so far as this 
symptom is concerned, has been reached. 

We observe these indications most commonly in febrile 
states, but there are not a few chronic conditions where the 
tongue will afford the needed hint for the correct remedy. 

I once cured a case of chronic ague of more than two 
years' standing, which had resisted all the antiperiodics 
of the three schools, with emetics administered twice a 
week for a month ; the indication for such treatment was 
prominent, and the indicated remedy, an emetic, proved 
successful. 

An obstinate case of dyspepsia, after being treated for 
years by different physicians and resisting my own efforts 
for a whole summer, yielded promptly upon the adminis- 
tration of the sulphite of sodium in appropriate doses. 
The indication was prominent from the start, but, like 
many another prescriber, I had too little faith in the 



78 THE PRINCIPLES OF SELECTION. 

remedy in such a disease to give it a fair trial in the 
commencement of the treatment. 

Dr. W- R. Lowman, already quoted (page 63), offers the 
following practical observations on tongue indications, 
which are worthy of notice, though they contain no ref- 
erence to specific therapeutic adaptation. 

"If of a smooth, pale, pinkish, moist, and elastic, resist- 
ive appearance all is well. As has been pointed out, if it 
is furred and of a dull, whitish hue, there is either in the 
organ itself "a congested or hyperacid condition" or 
asthenic condition of system with a local or other cause 
in proximity ; but if redness, with fur, there is a hyper- 
alkaline or inflammatory state. " 

"Fur indicates epithelialization, a hyperproduction, or 
non-removal by friction, as in fever. We have increased 
circulation and lack of attrition by want of appetite and 
consequent absence of mastication. Infants' tongues are 
white at the back part from lack of attrition. 

"White furred denotes non-attrition, oral inflammation, 
croup, pneumonia, measles, etc. 

"Yellow furred indicates hepatic derangement with re- 
tention of bile, fevers, etc. 

" Red, long, and pointed shows inflammation of stomach, 
bowels, etc. , diarrhea, etc. 

"Very red in scarlet fever (infant's strawberry), chronic 
diarrhea. 

" Clean and slightly coated in yellow fever. 

"Dry, cracked, scaly, and brown is seen in the latter 
stages of a long continued specific fever, like typhoid, or 
in rapid specific fever of high grade, as typhus. 

"Ridges, fissures, or sulci characterize the hepatic dis- 
orders so common to the South and malarial regions. 

" Cracked edges, derangement of kidney. 

"Eed, pointed, and dry denotes nerve irritation. 

"Broad and porous denotes imperfect elimination and 
muscular weakness. 



THE PKINCIPLES OF SELECTION. 79 

"Flabby and full denotes blood poverty and debility. 
"Dry in high temperature, profuse diaphoresis, diar- 
rhea or other exhaustiug discharges. 

" Coated or yellow in cancer of stomach. 
"Clean and reddish in ulcer of stomach. " 

THE NERVOUS SYSTEM. 

The functions of the nervous system may be stated to 
be the generation and conduction of vital impulses to dif- 
ferent portions of the body, and reception, by certain 
centers, of influences from external impressions made 
upon the peripheral extremities of sensory branches. 
To these we must add a higher function, that of the gen- 
eration of mental impressions, independently of the proc- 
esses of animal life. 

The anatomy of the nervous system consists of two 
classes of structure : (1) vesicular or generating structure, 
and (2) fibrous or conducting structure. 

The vesicular structure makes up the principal bulk of 
the generating centers, as the brain, spinal centers, and 
ganglia of the sympathetic, though the nerve fibers pene- 
trate them, to communicate with special cells or corpus- 
cles, the centers thus being connected and brought into 
relationship, through the fibers of the fibrous portion, 
with every part of the body; these fibers being intricately 
disposed and arranged, but each one serving, by its origin 
and termination, a special function, and conducting the 
same kind of impression in the one direction, always. 

The fibers which conduct impressions outward from 
nervous centers are termed centrifugal or efferent, while 
those which convey external impressions from without to 
nervous centers are termed centripetal or afferent. The 
centrifugal fibers convey motor, secretory, reflected, and 
trophic impulses; the centripetal fibers convey the various 
impressions imparted to the senses, as of pain, local irri- 
tation, and the special senses, to the central ganglia. 



80 THE PRINCIPLES OF SELECTION. 

The originating ganglia of nervous impulses are situ- 
ated, usually, within the cranium, though the fibers 
which proceed from them, in many instances, traverse 
secondary or subsidiary centers further down the track, 
which augment or modify, perhaps, the primary impres- 
sions. 

The originating centers of reflex action, however, are 
located in the spinal cord ; but even over these functions 
the brain exercises a certain controlling influence — not 
absolute, but sufficient, when concentrated, to hold in 
abeyance many impulses, which would naturally lead to 
irrational action. 

The integrity of the nervous system — perfect perform- 
ance of its functions — must depend upon (1) structural 
excellence of the generating centers, with proper relation- 
ship between them, (2) upon a normal condition of the 
conducting fibers, and (3) upon absence of abnormal irri- 
tation in any part of the body, to give rise to perverted 
reflex action. 

Degenerative changes or destruction of tissue in the 
nervous centers in any other way, will be the occasion of 
loss of power in the part or parts normally supplied with 
stimulus from the area of lesion, though the conducting 
medium be perfect ; and with normal generating power, if 
the nervous fiber which should conduct the impression be 
interfered with, in any part of its course, arrest or per- 
version of the function of the part supplied must follow. 

The therapeutics of the nervous system may be divided 
into (1) general and (2) special. 

The general therapeutics are such as apply, in principle, 
to other portions of the body — such as apply to the cir- 
culatory and interstitial functions. The circulation should 
be kept in proper balance, for no part of the body is more 
susceptible to effects of disturbance of the blood stream 
than the nervous centers. Besides the influence of the 



THE PRINCIPLES OP SELECTION. 81 

circulation on nervous structure, another important ele- 
ment is the plastic power residing there, and capable of 
being influenced bj remedies which specifically affect the 
offices of structure and function. 

To influence the circulation, the special sedatives are 
very appropriate, especially in acute diseases where the 
morbid condition is confined principally to the blood-ves- 
sels. Gelseminum in phrenitis, jaborandi in meningitis, 
and belladonna in capillary congestion, for instance, are 
remedies of unquestionable value. Then rhus tox. exerts 
an influence peculiar to itself upon the cerebral circula- 
tion — one of great value where the disturbance of the 
blood stream is more local than general, and marked by 
excessive excitation in the cerebral centers — out of pro- 
portion to the general vascular disturbance, with, perhaps, 
delirium. 

Professor Scudder, in his "Practice of Medicine," pro- 
poses to determine the condition of the cerebro-spinal 
system, so far as the application of the special sedatives 
is concerned, by the appearance of the eye, two condi- 
tions being defined : active (1) and passive (2) hyper- 
emia. Active hyperemia is evidenced by the bright eye 
and contracted pupil, restlessness, and other indications 
of determination of blood, and the condition is asserted 
to suggest gelseminum, which it undoubtedly does. 

On the other hand, the dull expressionless eye, with di- 
lated pupil and feeble circulation, is asserted to indicate 
the need of belladonna ; another indisputable proposition. 

I am of the opinion, however, that these remedies are 
not always confined to the conditions named. Bel- 
ladonna has controlled cerebral disturbance for me where 
the bright eye, flushed countenance, contracted pupil, and 
restlessness, seemed to call for gelseminum, after the lat- 
ter drug had failed to make an impression upon two days 
or more of trial ; but there was a debility of the general 
t 6 



82 THE PKINCIPLES OF SELECTION. 

circulation here which contra-indicated gelseminum, with 
marked local cerebral symptoms. As before remarked, 
gelseminnm should usually be thought of as a remedy for 
the determination of sthenia. Belladonna serves a good 
purpose in the condition of hebetude just described, but 
it also acts well in many cases of cerebral excitement, if 
the dose is minute ; the third decimal attenuation should 
be employed, however, in small quantities, when ad- 
ministered where the symptoms indicate cerebral excite- 
ment. 

Such agents as nitro-glycerine and nitrite of amyl, 
through their influence upon the inhibitory fibers of the 
pneumogastric, lessen arterial tension and thus diminish 
cerebral pressure. Many cases of cephalalgia are thus 
readily controlled by the effect of remedies which reach 
the nervous system only so far as exercising a certain 
control over the amount of blood in the part or over its 
rate of motion. 

Degenerative changes, however, soon follow upon long- 
continued vascular disturbance, and may arise independ- 
ently of them. Here we must rely upon agents which 
are more far-reaching in effect — remedies which have 
more to do with cell formation and the building of 
other histological elements. 

Then such agents as the phosphate of magnesium, or of 
potassium, or other inorganic elements of nervous struct- 
ure, may be found of better service — remedies which 
supply the elements of structure, as well as augment, 
perhaps, the tissue-building processes. Electro-therapeu- 
tics possess special virtues in either vascular or intersti- 
tial lesions. 

Special therapeutics of the nervous system have not 
yet been well developed. Physiology has but recently 
begun to locate special centers of function, and it is not 
strange that the therapeutist should have made but little 



THE PRINCIPLES OF SELECTION. 83 

headway in adapting his means to these discoveries. 
However, enough has been learned to suggest adaptation 
and perhaps stimulate further investigation, in a number 
of instances. 

THE CEREBRUM. 

The cerebrum is probably the center of all functions 
which connect the inner consciousness of the individual 
with the outer world, as of motion and sensation ; and it 
is also (1) the medium of perception of those clear and 
more impressive sensations, which can be retained, and 
regarding which judgment can be formed ; (2) also of the 
will, in so far as deliberate preconceived action is con- 
cerned; (3) of retaining impressions of sensible things, 
and reproducing them in subjective sensations and ideas; 
(4) of all the higher emotions and feelings, and of faculties 
of judgment, understanding, memory, reflection, induc- 
tion, imagination, and the like. 

Cerebral Centers. — Various centers of function have been 
localized in the cerebrum, of which knowledge is impor- 
tant, as it possesses a therapeutic bearing of no little con- 
sideration. These, as so far located, are (1) motorial or 
centers of motion situated upon each side of the cortex, 
upon areas corresponding to the ascending parietal and 
ascending frontal convolutions, the movements of the leg 
of the opposite side being represented at the upper part, 
and in succession downwards, the arms, the face, the lips, 
and the tongue. Then we have (2) the visual or optic 
center, located upon the outer convex part of each 
occipital lobe. The olfactory center (3j is believed to be 
in the anterior extremity of the unciate gyrus. The audi- 
tory center (4) is situated in the monkey's brain, in the 
first temporo-sphenoidal convolution, representing the 
auditory apparatus of the opposite side. Destruction of 
this center causes complete deafness of the opposite ear. 

Therapeutics of the Mental Sphere. — If the brain is the 



84 THE PRINCIPLES OF SELECTION. 

organ of the mind, and special regions are devoted to 
special functions, and special remedies manifest a selec- 
tive affinity for special parts, there is no reason that we 
shall not in time be able to control many morbid psy- 
chological manifestations with medicinal agents. Materi- 
alism thus offers a way for the accomplishment of what 
the "mind cure" crank will seek in vain. 

A few drugs affect cerebral functions notably. Hyos- 
cyamus, for instance, when given in material doses, just 
short of a poisonous effect, produces delirium, hallucina- 
tions, and garrulousness. The patient is inclined to be 
quarrelsome. 

Stramonium also disturbs the brain, but loquacity and 
quarrelsomeness are not among its prominent symptoms. 
The aberration produced is more of action and less of 
speech. Beverly describes the influence of stramonium 
upon soldiers who took an overdose at Jamestown, as 
follows : " They turned natural fools for several days. 
One would blow up a feather in the air, another would 
dart straws at it with much fury, and another, stark 
naked, was sitting up in a corner like a monkey, grinning 
and making mouths at them ; a fourth would fondly kiss 
and paw his companions, and sneer in their faces, with a 
countenance more antic than in any Dutch droll. In this 
frantic condition they were confined, lest they should, in 
their folly, destroy themselves, though it was observed 
that all their actions were full of innocence and good nat- 
ure. After eleven days they returned to themselves 
again, not remembering anything that had passed." 

Both hyoscyamus and stramonium influence the sexual 
propensities, the delirium of hyoscyamus being marked 
by obscenity, and those intoxicated by stramonium often 
exhibiting marked voluptuous and indecent sexual excite- 
ment, as, for example, by exposure of the sexual organs. 
The homeopathists regard the form of mania arising from 



THE PRINCIPLES OF SELECTION. 85 

disturbance of the reproductive apparatus coining on af- 
ter childbirth, — puerperal mania, — as especially calling 
for stramonium. 

An estimable lady, nearly past the climacteric, once 
complained to the writer of a disposition to quarrel with 
her husband. She averred that he was an indulgent hus- 
band and kind father to her children, but for all that 
every time he came into her sight the impulse to give 
him a scolding became irresistible. She had no reason 
for complaint, her domestic relations having always been 
pleasant, and she was sorry every time she gave way to 
the impulse, yet she could not help it. 

Ten drops of mother tincture of hyoscyamus were 
added to a four-ounce vial of water, and the patient di- 
rected to take a teaspoonful every three hours. In a 
few days she returned for certain local treatment, which 
had been going on for several weeks, and reported her 
quarrelsome disposition entirely gone. 

The tela aranese produces certain peculiar mental 
symptoms. If a drug impresses a part unpleasantly, les- 
sen the dose and you may fairly expect a pleasant and re- 
storative effect if the same locality be diseased. Upon a 
number of occasions I have had my patient complain of 
frightful dreams after the use of tela as a hypnotic. An 
old physician just convalescing from an attack of bronchi- 
tis, who had been sleepless for a number of nights, after 
taking small doses of this agent rested well apparently, 
and reported himself much refreshed in the morning, but 
asserted that he had been fighting wild animals all night, 
and this is the experience of many others who take it. 

The mental sphere of pulsatilla is familiar to the ma- 
jority of Eclectic physicians. Scudder gives the indica- 
tion as "a fear of impending danger. " In many cases of 
supposed heart disease we find pulsatilla to have a 
prompt and pleasing effect, but it is in those casas where 



86 THE PRINCIPLES OF SELECTION. 

the mind and not the heart is at fault. The patient 
comes complaining of unpleasant cardiac symptoms, and 
manifesting a dread of serious results. You make a care- 
ful and thorough physical exploration, and decide that no 
cardiac trouble is present, but that the difficulty lies in 
the sensorium. You prescribe pulsatilla and your patient 
soon reports the unpleasant heart symptoms gone. We 
often find this the case in instances where the mind of 
the patient centers itself on some other part of the body, 
and worries him into horrors over an impending doom. 
Pulsatilla relieves the brain symptoms if they are only 
functional, and the imaginary disease disappears. 

Numerous other agents exercise an influence in this di- 
rection, but the intent here is not to individualize drug 
action so much as to indicate the general application of 
different classes. In Specific Therapeutics this subject 
will receive ail the attention accessible material affords. 

The motor areas are not known to possess many thera- 
peutic affinities, though these doubtless exist. We must 
rely largely, for encouragement of muscular power upon 
those general measures which impart tone to the cerebral 
mass, with mechanico-therapeutics, faradism, etc., to aid. 
Nux vomica and its analogues excite the reflex centers in 
the spinal cord, but do not act through the brain, as is 
proven by the fact that after section of the upper por- 
tion of the cord the toxic action of the drug is still 
manifested by tetanic spasms in parts supplied by nerves 
which originate below the point of division, when intro- 
duced into the circulation. 

As the sensory fibers are distributed among the motor 
centers, peripheral influences are, doubtless, transmitted 
here in such a manner as to prove invigorating, when 
properly applied. In the absence of specific agents, then, 
we may directly reach these centers from the surface 
with massage, faradism, and like means. 



THE PRINCIPLES OF SELECTION. 87 

The prompt relief afforded by minute doses of mercury 
in languor, where there is good muscular development 
but sense of dread for voluntary movement, suggests an 
affinity here. This conviction must force itself upon any- 
one who has repeatedly observed the prompt restorative 
effect of mercurius dulcis in such cases. Perhaps, then, 
it would be best to make this single exception to the 
assertion that this center has no specifics. 

The optic centers possess therapeutic affinities of great 
worth, not only to the specialist, but to the general prac- 
titioner as well. Quite a number are at present known. 
Some of them act upon the circulation, as rhus, euphrasia, 
and conium ; others upon the centers of reflex action as 
calabar bean, belladonna, and pilocarpin. But the mech- 
anism and functions of the visual apparatus are so compli- 
cated that we cannot attempt to go very far into this 
subject without fear of confusion. Salicylate of sodium 
directly influences the visual centers, judging from the 
hallucinations which sometimes accompany its use. Nux 
vomica possesses the reputation of sharpening the vision. 
Other examples exist. 

The olfactory center possesses no drug affinities so far 
as at present known. 

The auditory center is impressible by some drugs. The 
tinnitus aurium due to the action of quinia is familiar to 
almost everyone. Salicylic acid also evidently influences 
this center, as it cures deafness attended by tinnitus, in 
some cases, where the auditory apparatus is intact. Oil 
of mullein has also been found a remedy for deafness, and 
its influence probably depends upon its affinity for this 
center. Pulsatilla, and piper methysticum, act, probably, 
through the afferent nerves of the auditory apparatus, as 
they relieve pain, but exert little influence in faulty hear- 
ing. 

The center for taste has not yet been localized. 



88 THE PRINCIPLES OF SELECTION. 

THE CEREBELLUM. 

The cerebellum is the center of muscular co-ordination. 
Destruction of this portion of the brain in the lower ani- 
mals, results in feebleness and want of harmony in the 
action of the various groups of voluntary muscles; and 
the power of preconcerted action, as springing, flying, 
walking, or standing, etc., is lost. 

" On the other hand, Foville supposed that the cerebel- 
lum is the organ of muscular sense; i. e. } the organ by which 
the mind acquires that knowledge of the actual state and 
position of the muscles which is essential to the exercise 
of the will upon them ; and it must be admitted that all 
the facts just referred to are as well explained on this 
hypothesis as on that of the cerebellum being the organ 
for combining movements. A harmonious combination 
of muscular actions must depend as much on the capabil- 
ity of appreciating the condition of the muscles with re- 
gard to the tension and to the force with which they are 
contracting, as on the power which any special nerve-cen- 
ter may possess of exciting them to contraction. And it 
is because the power of such harmonious movement 
would be equally lost, whether the injury to the cerebel- 
lum involved injury to the seat of muscular sense, or to 
the center for combining muscular actions, that experi- 
ments on the subject afford no proof in one direction 
more than the other. " — Kirkes Hand-book of Physiology. 

Therapeutic affinities for the cerebellum are as yet not 
well denned. Some drugs, notably alcohol, disturb the 
powers of co-ordination markedly, but that this is the 
effect of specific action so much as of a general influence 
in the blood which pervades all the tissues is a matter of 
doubt. 

THE MEDULLA OBLONGATA. 

This portion of the brain is intimately associated with 
the sympathetic nervous system, as well as receiving and 



THE PRINCIPLES OF SELECTION. 89 

transmitting fibers from the upper portions of the enceph- 
alon to the spinal cord. It also is the point of location 
of several important nervous centers which preside over 
special functions. 

The special centers in the medulla are as follows : — 

A center for the co-ordinated movements of mastication. 
No therapeutic affinities known. 

A center for the movements of deglutition. Through 
this, muscles of the palate, pharynx, and oesophagus, pro- 
duce the successive co-ordinate movements necessary to 
the act of deglutition. Therapeutic affinities : Lachesis, 
Pulsatilla, strychnia. 

A center for the co-ordinated movement of sucking, in- 
volving impulses along the facial for the lips and mouth, 
the hypoglossal for the tongue, and the inferior maxillary 
division of the 5th for the muscles of the jaw. No thera- 
peutic affinities known. 

A center for the secretion of saliva transmitting impulses 
by the chorda tympani and branches of the sympathetic 
to the salivary glands. Therapeutic affinities : Iris, jab- 
orandi, mercury. 

A center for vomiting. Therapeutic affinities : Ipecac, 
lobelia, tartar emetic, etc. 

A center for coughing, supposed to be separate from the 
inspiratory center. Therapeutic affinities: Cor allium 
rubrum, drosera, lachesis, sticta pulmonaria, tartar 
emetic. 

A center for sneezing. Therapeutic affinities : Alnus ser- 
rulata, aralia racemosa, sticta pulmonaria. 

A center for the dilatation of the pupil, from which pro- 
ceed fibers through the third nerve and the last two 
cervical and two upper dorsal into the cervical sympa- 
thetic. Therapeutic affinities : Belladonna, salicylic acid, 
santonin, etc. 

A respiratory center. Therapeutic affinities : Aspidos- 



90 THE PKINCIPLES OF SELECTION 

perma quebracho, cactus grandifiorus, hydrocyanic acid, 
lachesis, tartar emetic, etc. 

Vaso-motor center. " Experiments by Ludwig and others 
show that the vaso-motor fibers come primarily from 
gray matter (vaso-motor center) in the interior of the 
medulla oblongata between the calamus scriptorius and 
the corpora quadrigemina. Thence the vaso-motor fibers 
pass down in the interior of the spinal cord, and issuing 
with the anterior roots of the spinal nerves, traverse the 
various ganglia on the pre-vertebral cord of the sympa- 
thetic, and accompanied by branches from those ganglia, 
pass to their destination. 

"Secondary or subordinate centers exist in the spinal 
cord, and local centers in various regions of the body, 
and through these directly, under ordinary circumstances, 
vaso-motor changes are also effected. 

"The influence exerted by the chief vaso-motor centers 
is not only in constant moderate action, but may be al- 
tered in several, but chiefly by afferent (sensory) stimuli. 
These stimuli may act in two ways, either increasing or 
diminishing the usual action of the center which main- 
tains a medium tone of the arteries. This afferent influ- 
ence upon the center may be extremely well shown by 
the action of a nerve the existence of which was demon- 
strated by Cyon and Ludwig, and which is called the 
depressor, because of its characteristic influence on the 
blood-pressure. 

"Dejoressor Nerve. — This small nerve arises, in the rabbit, 
from the superior laryngeal branch, or from this and the 
trunk of the pneumogastric nerve, and after communicat- 
ing with filaments of the inferior cervical ganglion, pro- 
ceeds to the heart. 

"If during an observation of the blood-pressure of a 
rabbit this nerve be divided, and the central end (i. e., 
nearest the brain) be stimulated, a remarkable fall of 






THE PRINCIPLES OF SELECTION. 91 

blood-pressure ensues. The cause of the blood-pressure 
is found to proceed from the dilatation of the vascular 
district within the abdomen supplied by the splanchnic 
nerves, in consequence of which it holds a much larger 
quantity of blood than usual. The engorgement of the 
splanchnic area very greatly diminishes the blood in the 
vessels elsewhere, and so materially diminishes the 
blood-pressure. The function of the depressor nerve is 
presumed to be that of conveying to the vaso-motor cen- 
ter indications of such conditions of the heart as require 
a diminution of the tension in the blood-vessels; as, for 
example, that the heart cannot, with sufficient ease, pro- 
pel blood into the already too full or too tense arteries. 

"The action of the depressor nerve illustrates a some- 
what unusual effect of afferent impulses, as it causes an 
inhibition of the vaso-motor center. As a rule, the stim- 
ulation of the central end of an afferent nerve produces a 
reverse effect, or, in other words, increases the tonic influ- 
ence of the center, and by causing considerable constric- 
tion of certain arterioles, either locally or generally, in- 
creases the blood-pressure. 

" Thus the effect of stimulating an afferent nerve may be 
either to dilate or to constrict the arteries. Stimulation 
of an afferent nerve, too, may produce a kind of paradoxi- 
cal effect, causing general vascular constriction and also 
general increase of blood-pressure, but at the same time 
local dilatation, which must evidently have an immense in- 
fluence in increasing the flow of blood through the part. 

"Not only may the vaso-motor center be reflexly af- 
fected, but it may also be affected by impulses proceeding 
to it from the cerebrum, as in the case of blushing from 
mind disturbance, or of pallor from sudden fear. It will 
be shown, too, in the chapter on Respiration that the cir- 
culation of deoxygenated blood may directly stimulate 
the center itself. " — Kirkes Hand-book of Physiology. 



92 THE PRINCIPLES OF SELECTION. 

The therapeutic affinities of the vaso-motor center com- 
prise an extensive list. The "special sedatives" exert 
their influence through impressions made here, in all 
probability, and may produce effects of opposite nature, 
according to the size of dose administered. Minute doses 
act as vaso-motor stimulants, improving the tone of the 
circulation, while larger ones may impress the vaso- 
dilators and produce an inhibitory effect. Another class 
may act directly as vaso-motor depressors, producing an 
inhibitory effect from the start, though it is not improba- 
ble that the influence of all inhibitory agents is stimula- 
ting to the vaso-motor centers when administered in suffi- 
ciently small doses. 

Jaborandi in minute quantities improves the power of 
the heart and blood-vessels to carry on an equal and act- 
ive circulation, but in full doses its inhibitory effect is 
speedy and marked, the pallid, cold, clammy surface evi- 
dencing rapid departure of the blood from the superficial 
parts. Minute doses of nitro-glycerine also energize the 
circulatory functions, though in somewhat larger doses 
its vaso-depressor influence is unmistakable ; and so with 
aconite, veratrum, and other vascular sedatives, though 
some of this class act more directly upon the heart. 

Local centers have been shown to exist in the general 
vaso-motor tract, — centers which preside over such or- 
gans as the liver, spleen, and kidneys. Probably, further 
research will develop knowledge of a special center for 
every organ and distinct vascular area in the body. It 
is probable that here is the point of impression of spe- 
cific agents which influence the vascular state of various 
parts to control morbid action in them. Syzygium and 
nitrate of uranium have been suggested as agents influ- 
encing the diabetic center; doubtless renal, splenic, gastric, 
intestinal, and other groups exert an influence of this 
kind. 



THE PKINCIPLES OF SELECTION. 93 

The abdominal circulation is influenced by a class of 
agents which possess an effect opposite to that of the 
vaso-dilators. Probably there exists in the medulla, tonic 
centers, through which the vascular walls are strength- 
ened. It is evident, at least, that a class of agents like 
carduus marianus, grindelia squarrosa, polymnia, etc> 
tend to lessen the amount of blood in the abdominal 
vessels. 

A center for the secretion of siceat, which controls sub- 
sidiary spinal sweat centers, exists in the medulla. Ther- 
apeutic affinities : Jaborandi and other specific diaphoret- 
ics. Picrotoxine, atropia, and other agents which arrest 
profuse sweating, probably possess specific affinities for 
this center also. 

THE SPINAL COED. 

The spinal cord represents a column of conducting 
fibers which convey impressions from the brain toward 
the periphery, and vice versa, and from which is distributed 
to the vegetative system the filaments which serve largely 
to constitute its bulk. Within the fibers of this cord, 
however, are located at intervals masses of vesicular mat- 
ter — ganglia or special centers — many of which subserve 
functions subsidiary to those of the brain, though some 
of these — the reflex centers — are evidently independent. 

The functions of the cord are classed as conducting, 
transferring, and reflecting. 

The special centers of the cord, so far as located, are 
principally situated in the lumbar region. They are as 
follows : — 

A center for defecation. "The mode of action of the 
ano-spinal center appears to be this. The mucous mem- 
brane of the rectum is stimulated by the presence of 
feces or gases in the bowel. The stimulus passes up by 
the afferent nerves of the hemorrhoidal and inferior mes- 
enteric plexus to the center in the cord, situated in the 



94 THE PKINCIPLES OF SELECTION. 

lumbar enlargement, and is reflected through the puden- 
dal plexus to the anal sphincter on the one hand, and on 
the other to the muscular tissue in the wall of the lower 
bowel. In this way is produced a relaxation of the first 
and a contraction of the second, and expulsion of the 
contents of the bowel follows. The center in the spinal 
cord is partially under the control of the will, so that its 
action may be either inhibited or augmented or helped. 

" The action may be helped by the abdominal muscles 
which are under the control of the will, although under a 
strong stimulus they may also be compelled to contract 
by reflex action. " Therapeutic affinities : Collinsonia, 
sesculus glabra, aesculus hippocastanum, podophyllum. 
The influence of these drugs is probably peripheral, i. e., 
the primary action is upon the tissues of the rectum, and 
the impression transmitted to the spinal center by periph- 
eral branches. 

A center for micturition — vesico-spinal center. This 
center acts in a similar manner to the center for defeca- 
tion, the presence of urine in the bladder being the stim- 
ulus which excites the peripheral nerves and calls into 
action impulses in the center which are transmitted to 
certain muscles which contract, and to the sphincter, 
which relaxes. Therapeutic affinities : Cantharis, eryn- 
gium, gelseminum, nux, sabal serrulata, santonin, etc. 

A center for emission of semen. Therapeutic affinities: 
Phosphorus, avena sativa, gelseminum. 

A center for the erection of tlie penis. Therapeutic 
affinities: Cantharis, damiana, phosphorus, salix nigra; the 
latter, with other anaphrodisiacs, exerts a sedative or in- 
hibitory influence. 

A center for parturition, Therapeutic affinities : Caulo- 
phyllum, cimicifuga, ustilago, secale, etc. 

Centers of nutrition are believed to be located in the 
spinal cord, and probably possess their therapeutic affini- 






THE PKINCIPLES OF SELECTION. 95 

ties. Injury or disease of the cord is followed by atrophy 
and even by sloughing of the muscles, if serious in nature. 
The bones and joints are also subject to disease, when the 
cord is seriously affected. 

THE SYMPATHETIC NEEV0US SYSTEM. 

This system consists of several series of ganglia lo- 
cated outside the cranium and spinal canal, and princi- 
pally within the thorax and abdomen, which though inti- 
mately connected with the spinal cord (receiving and 
transmitting fibers from the spinal canal, which become 
minutely subdivided after association with them), possess 
an independent function of their own, viz., the power of 
perpetuating vital characteristics for a short time after 
separation from the central nervous system. 

The heart of a mammalian continues to beat one or 
two minutes, and that of an amphibian will pulsate for 
hours after complete removal from the body, evincing thus 
the fact that a kind of independent existence belongs to 
the parts supplied by this system, which maintains the 
functions of organic life without necessity of the con- 
sciousness or effort of the individual. 

The ganglia of the sympathetic are divided by Gaskill 
into four classes : (1) A connected double chain of lateral 
or vertebral ganglia ; (2) a more or less distinct prever- 
tebral chain consisting of the semilunar inferior mesenteric 
and similar plexuses; (3) a class of ganglia — terminal 
ganglia — situated in the organs and tissues themselves; 
and (4) the ganglia of the posterior spinal nerves. 

The functions of the sympathetic system seem to be 
(1) the perpetuation and distribution, in a modified form, 
of impulses from the cerebro-spinal system, the numerous 
ganglia sending out multiplied branches to preside over 
the functions of the cardio-vascular, absorbent, nutritive, 
secretory, and other involuntary functions, by which exist- 
ence is maintained, and (2) the perpetuation, in certain 



96 THE PBINCIPLES OF SELECTION. 

organs, of rhythmical action independent of the impulses 
from the central nervous system. For instance, the heart 
receives augmenting and inhibitory fibers from the cere- 
brospinal system, but rhythmical action in the organ 
depends upon the existence of terminal ganglia embedded 
in its walls, to which specific agents must be directed 
when irregular cardiac action, as intermittent beat, indi- 
cates disturbance of these centers. 

The sensation of pain, in parts supplied by the sympa- 
thetic, is usually slow in being aroused, but is persistent 
and difficult to control by agents which act directly upon 
the cerebro-spinal centers. Anodynes and narcotics 
reach parts supplied by this system with less certainty, 
and are often found but poor dependence in such cases. 
Many a case of fatal narcotism has been the result of the 
crowding of opiates for the relief of abdominal pain; the 
cerebro-spinal system has become paralyzed before the 
narcotic impression has reached the vegetative system 
with sufficient force to disguise the effect of the morbid 
state. 

Abdominal pain is more successfully and satisfactorily 
relieved by specific agents exerting an affinity for this re- 
gion, usually, than by opiates or other narcotics. 

The readiness of parts supplied by the sympathetic 
nervous system, to respond to remedies, is peculiar. In 
fact, a large share of the positive knowledge of therapeu- 
tics is what is known of the therapeutics of the thoracic 
and abdominal viscera. 

SECRETION AND EXCRETION. 

The act of secretion is the separation of specific prod- 
ucts from the blood, by glandular processes. Material 
separated for use in the body, or for the nourishment of 
the young, as the lacteal fluid, is termed a secretion; that 
for rejection, as waste, an excretion. 

The secretions are always separated by glandular ac- 



THE PRINCIPLES OE SELECTION. 97 

tion ; some of the excretions are simply strained through 
membranous walls, as the exhalation from the lungs; 
others, as, for instance, the epithelium, are removed by 
attrition, while the kidneys and sudiparous glands remove 
excretory products by a process similar to that by which 
the true secretions, as the milk, saliva, mucus, etc., are 
separated, — through the growth and deliquescence of 
cells. 

Every secreting apparatus consists of a basement mem- 
brane, supporting cells and blood-vessels, the vessels being 
placed in such intimate association with the cells that 
the latter multiply and grow rapidly during active stages 
of secretion, imbibing their pabulum from the blood and 
deliquescing at maturity, the resulting fluid constituting 
the secretion. 

Certain circumstances determine activity of secretion 
from a gland. These are : (1) The amount of blood, in the 
absence of febrile action ; (2) activity of the presiding 
nervous center; (3) amount of elaborative material in the 
blood capable of contributing to the formation of the se- 
cretion under consideration. 

Cerebral impulses favor secretion by imparting stimu- 
lus to the centers presiding over the gland, as when 
thoughts of food increase the flow of saliva in hunger. 

In febrile states, arrest of both secretion aod excretion 
is a prominent and persistent symptom, suggesting an 
intimate relationship between these functions and the 

circulation of the blood. When evidences of returning 

<~> 

secretion and excretion appear, a subsidence of the lever 
is regarded as a certain result — near at hand. 

The secretions subserve special purposes, each secre- 
t ory organ or apparatus being devoted, exclusively, to its 
own function, but the organs of excretion are more com- 
mon in their offices, the one sometimes performing vicari- 
ously the functions of another, as when in ' obstruction of 
7 



98 THE PRINCIPLES OF SELECTION. 

tiie tubules of the kidneys, the skin, by transference to a 
favorable climate or by the use of jaborandi, relieves the 
blood, (for a limited time at least, and to a certain extent) 
of urea. 

The three principal agents of excretion are the kidneys, 
lungs, and skin, and between these there is a certain 
reciprocity of action, though the kidneys excrete more 
largely of urea, the lungs of carbon dioxide, while the 
skin, to a more limited extent, in each case, performs 
both offices. 

The principles of dynamical therapeutics demand that 
in the influencing of secretion or excretion, avoidance of 
the large dose shall be observed. An organ unduly stim- 
ulated becomes debilitated in the end, and the purpose of 
medication is thus finally defeated. True, cases of emer- 
gency may demand the large dose, but this is contrary to 
the principles of sanative medicine, and should be aban- 
doned as soon as temporary results have been attained. 
Thus in anasarcous states, active hydrogogue cathartics 
may sometimes serve to rid the cellular tissues of an ob- 
jectionable accumulation of fluids, but this must always 
be at the expense of the integrity of the vascular tissues 
of the intestinal mucous membrane. So with powerful 
diuretics ; the kidneys may be stimulated to active work, 
for a time, and apparent good result follow, but there 
afterwards arises the question, How much have the renal 
tissues suffered from this excitement? 

The special sedatives are promoters of both secretion 
and excretion, by controlling vascular excitement, and 
thus relieving the special centers governing these func- 
tions, of embarrassing over-stimulation. How much con- 
tiguity of location and other relationship between the 
vaso-motor centers and the centers of control of these func- 
tions influence the result, is a question ; but, clinically, it 
ias been proven that in febrile states, the best remedies 



THE PRINCIPLES OF SELECTION. 99 

to improve secretion and excretion are those which equal- 
ize the sanguineous circulation, and reduce its movement 
to the normal rate. 

Diet and climate bear an important relation to the or- 
gans of excretion, especially in chronic disease. An over- 
plus of material consumed calls for undue effort for its 
removal, the proteids, particularly, when partaken in 
large amount, calling for extra work for their elimination. 
In the matter of climate, we must recollect that a cool, 
moist atmosphere lessens the ability of the lungs and 
skin to excrete, thus throwing more of a burden upon the 
kidneys; consequently, if these organs become diseased, 
a change is demanded. A warm, dry air will now throw 
more of the burden upon the lungs and skin, thus allow- 
ing the kidneys to rest. A cool, dry air permits the lungs 
to divide duty with the kidneys, to a certain extent, and 
is preferable to the damp atmosphere of the sea-coast in 
renal affections. On the other hand, many cases of ane- 
mia and general debility, with pulmonary and cutaneous 
relaxation brought on in the hot, dry climate of the in- 
terior, improve rapidly in the bracing atmosphere of the 
sea-shore, or in a more northerly latitude. 

The centers of control over secretion or excretion may 
be permanently injured by drugs which powerfully affect 
the medulla or spinal cord, and a state of cutaneous re- 
laxation result, which will be liable to persist for a life- 
time. This is especially so as regards ergot, a common 
class of such cases being women who have been overdosed 
with this drug by ignoramuses, during labor or for the 
purpose of producing abortion, a clammy, relaxed condi- 
tion of the skin, with attendant debility, permanently re- 
maining. 

There is also a probability that the kidneys may thus 
become permanently diseased. It is indisputably estab- 
lished that injuries to the brain may give rise to perma- 



100 THE PRINCIPLES OF SELECTION. 

nent relaxation of the capillaries of the kidneys or liver, 
and final structural change of the part congested. 

The important organs of secretion are the liver, pan- 
creas, salivary glands, mucous and serous membranes, 
and mammse. 

The liver has been sufficiently noticed in the considera- 
tion of the portal circulation. 

Of the pancreas little is known as regards its therapeu- 
tics. Its physiological affinities are iodine, iris, and mer- 
cury, but the application of these agents to diseases of 
the organ has never been made. 

The therapeutics of the salivary glands are of impor- 
tance with reference to excessive secretion — ptyalism. 
This may be controlled by minute doses of agents which 
manifest an affinity for the organs, as jaborandi, mercury, 
or iris versicolor. A better effect, however, may some- 
times be derived from galvanization of the tongue in the 
obstinate ptyalism of pregnancy. Lack of activity in the 
salivary glands usually depends upon constitutional 
states, which are reached by remedies that modify dis- 
turbance of the general circulation. 

The mucous membranes manifest various affinities in dif- 
ferent parts ; and these are so numerous that reference 
to Specific Therapeutics should be made, where they will 
be described in detail. 

Serous membranes possess few known affinities. Pos- 
sibly bryonia, apocynum, and sourwood, may specifically 
impart tone to them in relaxed conditions, but whether 
even this feeble influence is on account of any direct 
action upon the pavement epithelia, which constitute the 
secretory structure, is a matter of doubt. 

The mammary gland possesses a number of positive 
specifics. The vascular area described in the mamma is 
most markedly influenced by phytolacca, the gratifying, 
and almost certain action of this agent in mastitis, espe- 
cially that following childbirth, being one of the eminent 



THE PEINCIPLES OF SELECTION. 101 

certainties of medicine. The power of jaborancli to in- 
crease the flow of milk, of saw palmetto to influence nu- 
trition, and of bryonia to relieve painful conditions here, 
are also among the established facts of therapeutics. 

The specific affinity of castor-oil for the mammary gland 
should be recognized, as a warning against the stupid 
but time-honored custom of purging lying-in women with 
it upon the third day of confinement ; doubtless many a 
case of mastitis and resultant mammary abscess is set up 
by engorgement of the lacteal ducts in consequence of 
such practice. 

Crises in disease have been recognized since the days 
of antiquity. A favorable crisis is attended by sudden 
establishment of the secretions and excretions. The skin 
especially becomes bathed in profuse perspiration and 
convalescence immediately follows. The lesson suggests 
the propriety of endeavoring to establish an artificial 
crisis early in the course of severe fevers, as continued, 
typhoid, etc. Even if the disease cannot be abated by 
such efforts, its severity may often be so lessened as to 
leave but little after treatment necessary, except careful 
nursing. 

Such measures comprehend the use of the hot pack, 
the spirit vapor bath, or other powerful sudorifics, early, 
before the system has lost its reactive energies. 

TISSUE REGENERATION. 

The repair of injured tissue is a subject which suggests 
itself every day, to the inquiring physician. 

Three factors may be considered as exerting a con- 
trolling influence in the renewal of the life of the tissues : 
(1) The blood supply ; (2) the trophic nervous supply ; and 
(3) the formative force — plastic power — residing in the 
histological elements, or cells. 

These demand, as an indispensible requisite, proper 
pabulum, which will depend, for its production, upon 



102 THE PRINCIPLES OF SELECTION. 

appropriate food supply, normal digestion, and the due 
excretion of effete elements. 

The vascular supply serves at least, then, the purpose 
of the transportation of the elements of growth to, and 
those of decay from, the tissues ; partial arrest of the nor- 
mal blood-supply from a part is followed by atrophy, and 
complete arrest by death — gangrene. Proportionate to 
the amount of disturbance in the circulation of a part is 
its tissue integrity. Feeble capillary circulation with en- 
gorgement of the vessels is attended by all the unpleas- 
antness of a chronic inflammatory condition. 

Circulatory disturbances play an important part in 
almost every local lesion; whatever other factor is at 
fault, the circulation participates. In inflammation, one 
of the first evidences of pathological changes is that 
found in the blood-vessels ; this giving rise to increased 
rate of motion, attended by exudation and the transmi- 
gration of leucocytes, to be followed by rapid, cell prolif- 
eration. Later, sluggish movement, imperfect supply of 
nutritive material, and tardy removal of broken-down tis- 
sue follows. 

Function is thus impaired; and the circulation requires 
to be put in the best condition possible, that the life of 
the part may be sustained, its normal interstitial integrity 
restored, and its vital purposes subserved. 

It is a fact that all the demands of this subject cannot 
be satisfied by the administration of medicine. Mechan- 
ical causes may give rise to most mischievous results, and 
restoration may depend more upon an understanding of 
the principles involved, and rational application of appro- 
priate mechanical correction, than upon the selection of 
drugs. 

Thus, galloping consumption may prove speedily fatal 
in subjects whose lungs have been the seat of hypostatic 
congestion, due to long continued decubitus, without 



THE PEINCIPLES OF SELECTION. 10S 

change of position, while the parts are extremely debili- 
tated, as in typhoid fever. A threatened mastitis may he 
aborted, and even when developed, the action of the cor- 
rect remedies may be ranch aided by giving the gland 
proper support. An irritable ulcer upon the lower extrem- 
ity will soon heal, if the part be elevated, so that the hy- 
drostatic pressure consequent upon the upright position 
is removed, and the vascular congestion thus modified. 
Graily Hewitt ascribes chronic inflammatory conditions 
of the uterus to flexions and versions, and proposes to 
remedy these perverse conditions by correcting the dis- 
placement, thus removing obstruction to the vascular cir- 
culation at the cervix. 

Rest, also, may relieve the vascular engorgement — which 
perpetuates depravity of a tissue — and thus aid in its re- 
pair, as when the pulmonary mucous membrane is being 
congested and the condition continually aggravated by 
repeated coughing, such means as quiet the cough and af- 
ford the parts complete rest, conduce to restoration of the 
irritated .membrane. Here the will-power of the patient, 
if he can be shown the importance of exercising it, may 
be of utmost service. How many fatal cases of pulmo- 
nary disease might be averted, if the importance of smoth- 
ering the desire to yield to slight inclination to cough 
were recognized by the subject in the beginning ! 

The futile and illy-directed efforts of subjects afflicted 
with pharyngitis, laryngitis, coryza, dysentery (recto-coli- 
tis), cystitis, etc., in giving way to impulses due vascular 
congestion of the respectively diseased mucous surfaces, 
are frequent causes to which confirmed chronic diseases 
of the organs involved are referable at a later period, 
and should not be forgotten by the physician who prizes 
his reputation above mere lucrative results. 

The influence of remedies for the circulation, in sub- 
serving the integrity of the tissues, is of the highest im- 



104 THE PRINCIPLES OF SELECTION. 

portance. The field of therapeutics of the circulation, in 
this respect, should be separated into two departments : 
(1) That which considers remedies applicable to the gen- 
eral circulation, as the special sedatives, and (2) that 
which has to do with special vascular areas. 

To Scudder must be given much, if not all, the credit 
of adapting the special sedatives to the treatment of 
inflammatory conditions. Localized hyperemia, if acute 
in character, may be controlled nicely, in the majority of 
cases, by those remedies which modify excitement in the 
general circulation, and tend to equal distribution of 
blood. Determination to an irritated part is thus inhib- 
ited, the vessels strengthened, and the stream equally 
propelled to all parts of the body. 

Aconite, belladonna, gelseminum, jaborandi, veratrum, 
and other vaso-motor specifics, thus become important 
agents in guarding against excessive vascular disturbance 
in a part affected by inflammation, and by preventing ex- 
cessive tension and oxidation, maintain its vitality and 
conduce to ready restoration of affected parts after conva- 
lescence. 

But these may often be assisted or successfully set 
aside by agents which possess specific affinities for a 
given vascular area including the point of local irritation. 

Pharyngitis, for example, may be benefited by the sed- 
atives, and probably brought to a successful termination 
through their action upon the general circulation ; but 
Phytolacca so much more promptly controls the symp- 
toms that we must ascribe to it a specific influence upon 
the circulation in this part. True, the prompt action of 
this agent in healing aphthous ulceration, might suggest a 
tissue affinity of a different character, and it is not impos- 
sible that both virtues belong to the drug; i. e., a specific 
influence upon the vessels of the pharynx, through a spe- 
cial motor center, and an affinity for the structure of the 



THE PRINCIPLES OF SELECTION. 105 

oral mucous membrane, which adds to its plastic, or 
recuperative power. 

In laryngitis, the sedatives generally prove valuable, 
but certain drugs seem to exert a more marked influence 
than that which can be obtained by a general action upon 
the circulation at large. Aconite, while of less power as 
an inhibitory agent than some of the other cardio- 
vascular sedatives, perhaps, exerts here a speedy effect 
beside that of some others ; and potassium bichromate, 
though not an arterial sedative in any sense, removes 
subacute inflammation and regenerates tissue here with 
surprising readiness, when hoarseness is the prominent 
symptom. 

The vascular area described by the bronchial vessels 
offers another example. Veratrum here seems more ap- 
propriate than other arterial sedatives, but asclepias 
tuberosa, while a feeble cardiac sedative, if it exerts any 
influence at all, excels even that powerful vaso-depressor, 
hellebore, in controlling excitation in this area; and so we 
find it with ipecac, as regards the enteric mucous mem- 
brane, collinsonia in rectal disturbances, etc. 

Little is known of the influence of the nervous system 
over the regeneration of tissue, that can exert a thera- 
peutic bearing. Trophic centers evidently exist in the 
spinal cord, and probably possess their affinities, which 
may yet be discovered and found to possess therapeutic 
uses, but at present we can only recognize the principle 
and lay it by for future reference, when we have passed a 
little further along the road of therapeutic discovery. 
We will, therefore, suspend further judgment upon this 
part of the subject, and quote a few paragraphs, upon the 
relation of the nervous system to nutrition, from "Kirke's 
Hand-book of Physiology": — 

"It has been held that the nervous system cannot be 
essential to a healthy course of nutrition, because in 
plants and the early embryo, and in the lowest animals, 



106 THE PBINCIPLES OF SELECTION. 

in which no nervous system is developed, nutrition goes 
on without it. But this is no proof that in animals which 
have a nervous system, nutrition may be independent of 
it; rather, it may be assumed, that in ascending devel- 
opment, as one system after another is added or increased, 
so the highest (and, highest of all, the nervous system) 
will always be inserted and blended in a more and more 
intimate relation with all the rest ; according to the gen- 
eral law, that the interdependence of parts augments with 
their development. 

"The reasonableness of this assumption is proved by 
many facts showing the influence of the nervous system 
on nutrition, and by the most striking of these facts be- 
ing observed in the higher animals, and espesially in man. 
The influence of the mind in the production, aggravation, 
and cure of organic diseases is matter of daily observa- 
tion, and a sufficient proof of influence exercised on 
nutrition through the nervous system. 

"Independently of mental influence, injuries either to 
portions of the nervous centers, or to individual nerves, 
are frequently followed by defective nutrition of the parts 
supplied by the injured nerves, or deriving their nervous 
influence from the damaged portions of the nervous cen- 
ters. Thus, lesions of the spinal cord are sometimes 
followed by mortification of portions of the paralyzed 
parts; and this may take place very quickly, as in a case 
in which the ankle sloughed within twenty-four hours 
after an injury of the spine. After such lesions also, the 
repair of injuries in the paralyzed parts may take place 
less completely than in others; so, in a case in which 
paraplegia was produced by fracture of the lumbar verte- 
brae, and, in the same accident, the humerus and tibia 
were fractured. The former in due time united ; the lat- 
ter did not. The same fact was illustrated by some ex- 
periments, in which having, in salamanders, cut off the 



THE PRINCIPLES OF SELECTION. 107 

end of the tail, and then thrust a thin wire some distance 
up the spinal canal, so as to destroy the cord, it was 
found that the end of the tail was reproduced more 
slowly than in other salamanders in whom the spinal 
cord was left uninjured above the point at which the tail 
was amputated. Illustrations of the same kind are fur- 
nished by the several cases in which division or destruc- 
tion of the trunk of the trigeminal nerve has been fol- 
lowed by incomplete and morbid nutrition of the corre- 
sponding side of the face, ulceration of the cornea being 
often directly or indirectly one of the consequences of 
such imperfect nutrition. Part of the wasting and slow 
degeneration of tissue in paralyzed limbs is probably 
referable also to the withdrawal of nervous influence 
from them ; though, perhaps, more is due to the want of 
use of the tissues. 

" Undue irritation of the trunks of the nerves, as well 
as their division or destruction, is sometimes followed by 
defective or morbid nutrition. To this may be referred 
the cases in which ulceration of the parts supplied by 
the irritated nerves occurs frequently, and continues so 
long as the irritation lasts. Further evidence of the in- 
fluence of the nervous system upon nutrition is furnished 
by those cases in which, from mental anguish or in severe 
neuralgic headaches, the hair becomes gray very quickly, 
or even in a few hours. 

"So many and varied facts leave little doubt that the 
nervous system exercises an influence over nutrition as 
over other organic processes; and they cannot be easily 
explained by supposing that the changes in the nutritive 
processes are only due to the variations in the size of the 
blood-vessels supplying the affected parts, although this 
is, doubtless, one important element in producing the 
result. 

"The question remains, Through what class of nerves 



108 THE PRINCIPLES OF SELECTION. 

is the influence exerted? When defective nutrition occurs 
in parts rendered inactive by injury of the motor nerve 
alone, as in the muscles and other tissues of a paralyzed 
face or limb, it may appear as if the atrophy were the di- 
rect consequence of the loss of power in the motor 
nerves ; but it is more probable that the atrophy is the 
consequence of the want of exercise of the parts ; for if 
the muscles be exercised by artificial irritation of their 
nerves their nutrition will be less defective. The defect 
of the nutritive process which ensues in the face and 
other parts, however, in consequence of destruction of the 
trigeminal nerve, cannot be referred to loss of influence 
of any motor nerves ; for the motor nerves of the face and 
eye, as well as the olfactory and optic, have no share in 
the defective nutrition which follows injury of the tri- 
geminal nerve ; and one or all of them may be destroyed 
without any direct disturbance of the nutrition of the 
parts they severally supply. 

"It must be concluded, therefore, that the influence 
which is exercised by nerves over the nutrition of parts 
to which they are distributed is to be referred, in part or 
altogether, either to the nerves of common sensation, or 
to the vaso-motor nerves, or, as it is by some supposed, 
to nerve fibers {trophic nerves), which preside especially 
over the nutrition of the tissues and organs to which they 
are supplied. 

"It is not at present possible to say whether the influ- 
ence on nutrition is exercised through the cerebro-spinal 
or through the sympathetic nerves, which, in the parts on 
which the observation has been made, are generally com- 
bined in the same sheath. The truth perhaps is, that it 
may be exerted through either or both of these nerves. 
The defect of nutrition which ensues after lesion of the 
spinal cord alone, the sympathetic nerves being uninjured 
and the general atrophy which sometimes occurs in con- 



THE PRINCIPLES OF SELECTION. 109 

sequence of diseases of the brain, seem to prove the influ- 
ence of the cerebro-spinal system ; while the observation 
that inflammation of the eye is a constant result of liga- 
ture of the sympathetic nerve in the neck, and many 
other observations of a similar kind, exhibit very well the 
influence of the latter nerve in nutrition." 

A plastic power or formative force, which shapes the 
building of plastic material into determinate forms, is uni- 
versally recognized. This principle exists in the sim- 
plest forms of organic life, endowing the individual with 
the faculty of reproducing like forms from nutritive pabu- 
lum. 

The simplest creatures thus respond to this principle, 
and, as higher forms are reached, it is not in the least 
probable that this endowment becomes lost. True, 
trophic impulses may produce certain effects through ner- 
vous supply, but these cannot furnish that element which 
gives individuality to the recuperative power of every 
portion of the body, existing within itself. 

When the vitality of a part becomes impaired by injury 
or disease, this recuperative energy suffers, along with the 
general impairment of structure, and promptness of repair 
will be in proportion to the amount of plastic force re- 
maining. The relation of formative force to a part may 
be illustrated by the following simile : — 

"Suppose a carpenter builds himself a house, and a cy- 
clone comes along after it is finished and whirls it into 
fragments, injuring in the meantime its owner. Now, 
suppose there is no other builder to be had and that the 
same carpenter in a crippled condition — arms, shoulders 
and other parts of the body somewhat impaired in their 
functions — is obliged to build another. The process will 
evidently be a slow and unsatisfactory one, and when the 
second structure is finished it will be inferior to the first, 
even though all the material furnished should be first- 



110 THE PEINCIPLES OF SELECTION. 

class. Suppose, however, this structure is destroyed, but 
the owner this time escapes injury. He has now some- 
what recovered from the effects of the cyclone and is able 
by extra effort to construct a better building than the last 
one. He has been improving, gathering strength as it 
were, and with the same quality of material approaches a 
little nearer perfection than before, when impairment of 
his locomotor and prehensile functions unfitted him, and 
after he has several times repeated the process he comes 
quite near the standard of his former excellence, before 
his injury disqualified him for the purpose." 

So it is with a part injured by disease. The blood for 
its regeneration may be of the best quality, but the 
builder — the plastic principle, the formative force — has 
been impaired, and though the blood-vessels carry good 
building material to the part the cellular elements fail to 
construct good protoplasm from it, and an imperfect struct- 
ure gradually takes the place of that weakened by dis- 
ease. But the tissues are constantly being broken down 
and repaired, and the physician can aid this formative 
force by selecting such agents as specifically influence the 
affected part to improve its recuperative energies ; he can 
further augment its vitality by the local application of 
properly selected electrical currents ; he can guard the 
part from undue tension or over-exertion by proper at- 
tention to details, and after a time, even though the con- 
dition has become chronic, he can effect a renewal of the 
life of the part — an approach towards, if not a complete, 
recovery resulting. 

The nutritional affinity of certain drugs for special por- 
tions of the body seems unquestionable ; and in some 
cases this affinity is so powerful as to prove destructive. 
Potassium bichromate destroys the mucous membrane of 
the respiratory and digestive tracts, in persons subjected, 
for a time, to material doses, and it also exerts a healing 



THE PRINCIPLES OF SELECTION. Ill 

effect here, when administered in doses sufficiently small 
to stimulate the formative force of the affected part with- 
out injury. 

It might be claimed that such an effect was due to the 
influence of the drug upon the circulatory area of these 
parts, but we may refer to the influence of silica upon 
cartilage, or that of cineraria upon the humors of the eye, 
where no blood-vessels are found, in refutation. 

The selective influence of sabal serrulata upon the 
prostate gland, testes, and mammae, is evidently not of a 
vaso-motor kind, but one in which the plastic power is 
concerned — an influence which betters the condition of 
the parts to appropriate nutriment, and form it into struct- 
ure of the best quality. 

Remedies which improve the formative force of a part 
must not be expected to accomplish all that is possible of 
them in a limited time ; we must not expect any remedy 
to bring about its effects magically or immediately; such 
an idea would have done better for the da} r s of supersti- 
tion; there must be successive pulling down and building 
up, repeatedly, upon an improved basis each time, as the 
architect improves in power, before a chronically diseased 
part can reach a perfectly normal condition. 

I once administered penthorum sedoides to a patient 
afflicted with chronic inflammation of the upper portion 
of the pharynx, for a year steadily ; in the beginning the 
parts affected presented a bluish, dry, shiny appearance, 
which had been present for fifteen years. The influence 
of the remedy was slow, but certain, and when treatment 
was discontinued, the color, secretion, general appearance, 
and sensation of the parts, were normal. Yet we would 
not expect such an effect from penthorum upon any other 
portion of the body, nor need we expect it in acute cases, 
where the lesion is largely circulatory. 



112 THE PRINCIPLES OF SELECTION. 

THE NEW FORMATIONS. 

It might be considered a question whether this subject 
is of sufficient importance to justify its notice in a work 
on therapeutics. However, the fact that new growths, in 
some instances, can be influenced by remedies through 
the circulation is generally recognized, and, possibly, when 
studied more carefully, the subject may be made much 
worthier a place in the therapeutics of the future. 

There is probably a class of new formations which are 
so near normal tissues in their structure and place of de- 
velopment, that drugs may be made to exert an affinity for 
them, while in another instance the growth may be devel- 
oped under such abnormal conditions that drug affinity 
cannot produce any effect upon it. 

Take, for instance, enchondroma : We have here a 
growth histologically resembling cartilage and following 
the same developmental course, originating either from 
connective tissue or bone, its connection and evolution 
then, in a certain respect, coinciding with those of normal 
cartilaginous tissue. And there is so close a relation be- 
tween this growth and normal cartilage, that drugs which 
manifest an affinity for the latter tissue might reasonably 
be expected to manifest a like affinity for the morbid de- 
velopment. 

We are credibly informed that silica possesses the 
power of arresting the development of enchrondomata, 
and, while I have never proven the matter in practice, the 
prompt action of this agent upon true cartilage seems to 
me to justify the belief that such statement may be cor- 
rect. 

Excessive development of the epithelium of the seba- 
ceous follicles, in the form of verrucae (warts), is another 
example where drugs, through the circulation, have been 
known to perform a cure. Here, also, there is such a 
close connection between normal tissue and morbid devel- 



THE PKINCIPLES OF SELECTION. 113 

opment that the histological elements retain a certain 
normal selective power, perhaps, and are therefore amen- 
able to the influence of such agents as thuja and magne- 
sium sulphate, — drugs which have been known to effect 
the removal of such growths, when administered inter- 
nally. 

But take such a growth as a dermoid cyst, — a morbid 
development of the ovary, apparently, yet one containing 
the histological elements of the true skin, in its compo- 
sition of cells of corium and epidermis, containing seba- 
ceous and hair follicles and sweat glands, as well perhaps 
as teeth. Here we have a transplanted tissue developing 
in a field isolated from its normal position, the result, 
perhaps, of aberrant cells from the epiblast, lost during 
early embryonic development, so far removed from their 
normal position that drug affinity through vasomotor or 
trophic centers evidently could not exist, nor could the 
attraction ordinarily believed to be exerted between nor- 
mal histological elements and drugs be expected to re- 
main with. them after removal to so remote a field from 
the mother soil. 

Cancer, also, probably the result of accidental trans- 
plantation of epithelial cells to that hot-bed of prolifer- 
ation, connective tissue, affords another example where 
little, if any, drug affinity could be expected to exist, if we 
accept the proposition that the underlying principle of 
drug affinity is that the attraction must always be be- 
tween healthy parts and specified drugs, and that in dis- 
ease the same drugs act upon the normal elements, in- 
stead of selecting parts because of morbid changes. 

Dr. Cutter has proposed, probably, the best method of 
cure for cancer — that of starvation ; otherwise, a diet con- 
sisting of the one article of food, chopped beef, which 
means only the consumption of barely enough to sustain 
life. Here the power of the normal elements to appro- 
8 



114 THE PRINCIPLES OF SELECTION. 

priate what is needed robs the exuberant growth that is 
rapidly developing and closing up the avenues of life, of 
needed nourishment, and arrest of its progress results. 
Such a growth is isolated, biologically, from any base of 
operation by which a tissue remedy can exert an influ- 
ence upon it, for though it is a tissue of normal resem- 
blances, in some respects, it is growing out of place. 

It seems to me that the physiological action of drugs 
limits their capacity to exert effects in disease. In other 
words, any agent capable of acting as a remedy must pos- 
sess the power of specifically influencing, either through 
vasomotor centers or direct action upon the tissues them- 
selves, the circulation of a given part, or through trophic 
nerve centers its nutrition, or by specific affinity for the 
cells themselves, the plastic power presiding over them. 

When new growths are not isolated from the normal 
tissues from which they originate, but are histologically 
modified parts of them, or are intimately related, we may 
reasonably expect the tissue affinities of drugs to be ex- 
erted upon them ; but when tissue grows out of place, has 
been transplanted, or develops an entirely new character, 
it is reasonable to suppose that that intimate relation- 
ship which exists between all the normal tissues has been 
severed, and the knife or other destructive means outside 
the field of therapeutics becomes the only reliable means 
of removal. 

PAIN. 

Pain is an almost inseparable symptom of disease un- 
less there is loss of sensation in the affected part. True, 
the pain may not always be referable to the point of le- 
sion, but may be reflected to a distant portion of the body. 
Still, a sense of local discomfort is almost invariably pres- 
ent, constantly or at intervals, either in the part affected, 
or in some locality, or localities, to which the irritation 
or disturbance is reflected. 



THE PPJNCIPLES OF SELECTION. 115 

Pain may be defined as an aggravated sense of discom- 
fort, so pronounced in character as to enable the subject 
to locate it. Its character may vary, being in some cases 
dull, in others aching, sharp, burning, gnawing, stabbing, 
etc. It may be constant, intermittent, remittent, or er- 
ratic or changeable, as to its location. It may be so slight 
as to simply attract the attention of the patient, to the 
point of attack, or so severe as to drive him frantic with 
suffering. 

The immediate seat of pain is some portion of the sen- 
sory nerves, but the primary cause may lie outside these 
tissues, as, for example, in inflammation the interstitial 
changes may give rise to pressure or other irritation of 
nerve fibers, a condition demanding the removal of inflam- 
matory hyperemia, in order that the pain may subside. 
Spasmodic contraction of irritated muscles may be the 
cause of intense pain, from the effects of severe pressure 
upon branches of the afferent nerves. In other cases dis- 
turbances in the nerves themselves may be the origin of 
the pain, -as in many cases of neuralgia from irritation of 
a dental pulp, or pressure upon some nerve trunk, or cir- 
culatory changes in the nerve trunks or ganglia. Impov- 
erished conditions of the general system may give rise to 
pain in a nerve on account of deficient supply of nourish- 
ment to the part. Encroachment of new growths upon 
normal tissues may result in pressure or dragging, which 
may amount to severe pain. Ulceration of tissues gives 
rise to exposure of nerve fibers, and resultant irritation 
and pain. 

The rational treatment of pain embraces a lengthy list 
of remedies, though the indolent or careless physician 
will expect to succeed with a very limited number, and of 
these opium, or its preparations, will constitute the prin- 
cipal resource. 

These remedies may be divided into general and spe-^ 



116 THE PRINCIPLES OF SELECTION. 

cial. General remedies are those which exert a control- 
ing influence over the general circulation, especially in the 
nervous tissues, as aconite, or such as add to the nutri- 
tional power there, as phosphorus, magnesium, or potas- 
sium phosphate, or such remedies as stimulate the circu- 
lation in the part, as arsenic. Special remedies are those 
which, acting through their tissue affinities, impress local 
regions specifically, to influence circulatory lesions, relax 
morbid spasm, control irritation, or improve nutrition, 
in special nerve fibers. 

The most satisfactory method of studying this subject 
is to formulate pain expressions with their specific reme- 
dies: — 

Aural pain (earache) calls for chamomilla, piper me- 
thysticum, pulsatilla, verbascum thapsus (oil of). 

Cardiac pain calls for nitrite of amyi, if from angina 
pectoris ; in cardiac rheumatism, antipyrin, cimicifuga, 
caulophyllin, jaborandi, the salicylates, etc. Cardiac neu- 
ralgia may call for magnesium phos. 

Ccecal pain calls for lachesis. 

Cerebral pain of full, throbbing character calls for nitrite 
of amyl, nitro-glycerine, antifebrin, or antipyrin. When 
more than evanescent in its continuation, aconite and gel- 
seminum. 

Cerebral pain of dull character, with facial pallor and 
coldness of the extremities, belladonna or ustilago maidis. 

Cutaneous pain, burning, with stinging and pungent heat, 
apis, citric acid (locally), rhus tox. 

Enteric pain (colic), griping, twisting, about and above 
the navel, colocynth, dioscorea; in dysentery or cholera 
infantum, ipecac should be alternated with the one chosen. 
The pain of winter diarrhea calls for potassium bichrom- 
ate 2x. In muco-enteritis, epilobium should not be 
forgotten. Pain in the hypogastric region, when intes- 
tinal in origin, calls for collinsonia. 

Facial pain ( Tic dohreux) calls for piper methysticum. 



THE PRINCIPLES OF SELECTION. 117 

Gastric pain calls for cimicifuga or caulophyllin, if 
muscular in character ; gastric neuralgia, antipyrin, colo- 
cynth, magnesium phos., pulsatilla. 

Hepatic pain calls for bryonia, chelidonium, colocynth. 
Biliary colic (gall-stone spasm), benzoate of lithium, olive 
oil, salol. 

Muscular pain, dull, aching, without swelling of parts, 
calls for full closes of cimicifuga (a decoction is the most 
reliable, in tablespoonful doses). 

Muscidar pain, full, tense, severe (parts swollen), great 
aggravation upon the least motion, jaborandi (full doses 
of the green preparation — specific medicine). This is 
the most reliable remedy in inflammatory rheumatism, 
administered until its inhibitory effect is marked by cool, 
clammy skin. 

Muscular pain, sharp and lancinating at times, erratic, 
shifting suddenly, antipyrin; give five-grain doses every 
four hours until better. 

Myalgia (pain in the muscles on motion with relief 
upon rest), chronic, hydrastis canadensis (minute doses). 

Neuralgic pains (at large) in anemic, ill-nourished sub- 
jects, without threatened change of structure, phosphorus. 
If there is loss of memory, occasional aberration, and 
other symptoms of pending organic change, potassium 
phos. Darting, stitching pains, in such cases, may be 
more speedily benefited by the addition of magnesium 
phos. 

Occipital pain extending from the shoulders and neck, 
sticta. — Scudder. 

Odontalgia (toothache) calls for aconite, plantago major, 
piper methysticum. An exposed pulp or diseased fang 
will demand operative interference. 

Orchialgia (pain in the testicle) calls for cimicifuga, if 
the patient is of rheumatic diathesis and the case is 
■chronic, or sabal serrulata, when there is prostatic irri- 



118 THE PRINCIPLES OF SELECTION. 

tation or sexual neurasthenia ; pulsatilla, if acute inflam- 
mation exists. 

Ovarialgia (pain in the ovary), cimicifuga, hamamelis, 
lilium tigrinum, ustilago, valerinate of zinc. 

Pericranial pain, antipyrin, cimicifuga, faradism, sali- 
cylic acid. 

Periosteal pain calls for chloride of gold, iodide of po- 
tassium, manganese, silica. 

Rectal pain calls for a3sculus, when sharp and cutting, 
with distress in the sacral region ; collinsonia, when the 
rectal pain is complicated with pain in the hypogastric 
region; hamamelis, when there is marked local sense of 
fullness and weight. 

Sciatica, when radiating about the hip joint, colocynth ; 
when the entire nerve is involved, the sulphur pack, salol,. 
the faradic current, downward. 

Spinal pain, severe and draiving, with contraction of the 
dorsal muscles (spinal meningitis), jaborandi. 

Splenic pain calls for carduus marianus, ceanothus 
Americanus, grindelia squarrosa, or polymnia uvedalia. 

Thoracic pain (pleurodynia) calls for bryonia, cimicif- 
uga, caulophyllin. The agonizing pain of pleuritis calls 
for nauseating doses of lobelia (a decoction of the fresh 
plant or saturated tincture of the seed). 

Uterine pain (dysmenorrhea) calls for antipyrin, cim- 
icifuga, leontin, pulsatilla, viburnum prunifolium. 

Vaginal, stitching, sense of weight, dyspreunia, sepia. 

Vesical pain calls for eryngium aquaticum, rhus aro- 
matica ; if prostatic irritation exists, sabal serrulata, staph- 
isagria. 

But therapeutics are not yet so perfected that narcotics 
can always be wholly dispensed with. Morphia and the 
other preparations of opium are sometimes valuable means 
to resort to, as well as chloral, ether, chloroform, etc. 



THE SCIENCE AND ABT OE PRESCRIBING. 119 



THE SCIENCE AND ART OF PRESCRIBING. 

Consideration of certain subjects included under this 
heading is as important as the principles of selection, in 
order that success may attend the efforts of the thera- 
peutist. 

The adaptation of the remedy may be correctly made 
and yet treatment prove a failure, because the drug lacks 
its proper medicinal virtue ; quality of drug then is an 
important consideration. Or, the dose may be so large 
that dynamical effect is embarrassed and the function 
sought to be improved unpleasantly disturbed; or the 
dose may be so small as to fail in producing the neces- 
sary amount of disturbance requisite for a salutary effect; 
or, possibly, the drug may have been administered at the 
wrong time to produce the desired result, or it may 
have been given in combination with such agents as inter- 
fered with its proper action (incompatibles). 

The convenience of the prescriber is also to be taken 
into account, as regards the portableness of his medicines, 
if he be so situated that it becomes necessary for him to 
carry them. This will lead to the consideration of bulk, 
form for administration, etc. 

THE QUALITY OF DRUGS. 

The reader will agree with me that in the matter of 
drugs, as well as in many other respects, there is very 
little in a name. A number of years ago, while practic- 
ing in Missouri, I needed some gelseminum, and desired 
it very much. My vial of special preparation was ex- 
hausted, and the only recourse was to apply at the village 
drug store. Sure enough, the apothecary had "Tinct. 
Gelseminum," duly labeled, on his shelves, and an ounce 
was procured, and the remedy administered, but with no 
response, a. larger dose was given, but still no effect was 






120 THE SCIENCE AND AKT OF PEESCBIBING. 

manifest, and I found, upon actual trial, that a full tea- 
spoonful failed to produce any of the influence of active 
tincture of gelseminum. 

The tincture had been made, as I learned subsequently, 
of a dried root of which the druggist could afford no idea 
of the age. It had been in his own shop several years 
at least before the tincture was prepared. This is a sin- 
gle instance of a great number of unsatisfactory results 
which have followed the administration of drugs of ques- 
tionable source within the past twenty years, and I am 
confident my experience has been but a parallel to that 
of the majority of physicians. 

We become after a time, distrustful of a remedy unless 
we know the source is reliable. The assurance of the 
druggist as to the qualities of a drug, amounts to little, for 
he is usually unqualified, except to declare that the proc- 
esses of manufacture have been legitimately carried out. 
No one not positively knowing the age of the crude 
material, is competent to say that a pharmaceutical prep- 
aration contains the active principles of the drug it rep- 
resents, unless the material is of an imperishable char- 
acter, and this cannot be said of crude organic products. 

There is no wonder that the average "regular" has so 
little faith in indigenous remedies — that he confines him- 
self to a very small group of agents, and these principally 
chemicals of the kind that cannot deteriorate with age. 
Who has not whiffed the musty odors of an old-fashioned 
blue-pill doctor-shop? The most unreliable place in the 
world to purchase a preparation of a vegetable remedy, 
is a drug store patronized exclusively by "regular" phy- 
sicians. Go to such a place and order tincture of aconite 
or cimicifuga, or any other tincture of a perishable arti- 
cle, and you may get a good drug, and you may not ; 
the chances are you will be disappointed. 

The stuff may have the color, the odor, and, possibly, 



THE SCIENCE AND AKT OF PRESCRIBING. 121 

the taste, but the probabilities are that your patient will 
fail to improve under its influence, as you have a right to 
expect. The material was old and musty, perhaps, be- 
fore the tincture was made, and was as innocent of medic- 
inal principle as the most inert substance in the world, 
or, possibly, the tincture may have been made of a poor 
fluid extract, by adding one part to fifteen of alcohol. 

I may be late in the day in making these accusations. 
Old-school physicians near the centers of medical learn- 
ing are waking up to the importance of reliable drugs, 
but the country cousin is still a hundred years behind 
the times in this respect. 

The successful practitioner of medicine is on the alert 
to know what quality of remedy his patient is taking. 
He realizes the unreliability of the general drug market, 
in many respects, and demands that his prescriptions 
shall be filled with the preparations of some well-known, 
well-tried, and reliable firm. There are a number of 
these houses in the United States, and preparations bear- 
ing their labels, if genuine, may be depended upon. 

Among these it affords us pleasure to mention Lloyd 
Brothers, of Cincinnati, Parke, Davis & Co., of Detroit, 
and Eli Lilly & Co., of Indianapolis. The Specific Med- 
icines are always reliable and have contributed a large 
share toward the success achieved by our school in recent 
times. The Normal Liquids are also worthy of special 
mention. 

Druggists are usually honest ; however, sometimes we 
may reasonably suspect they have substituted their own 
or some other cheap article. When there is the least 
ground for suspicion that the best of drugs are not sup- 
plied, the physician will save credit to himself and confer 
a favor upon his patrons, by keeping his own medicines 
in stock and dispensing them when needed. 

There is a class of supplies which are imperishable, as 



122 THE SCIENCE AND AET OF PKESCKIBING. 

the vegetable alkaloids, mineral salts, etc., but these, if 
expensive, may have been adulterated until a given quan- 
tity represents less than half the ordinary strength. 

I have never found any of the vegetable remedies in a 
more reliable form than a tincture prepared from the 
fresh material in the proportion of a pound of the crude 
article to the pint of menstruum, bruised and covered 
with alcohol the same day it is gathered. This repre- 
sents the most refined pharmacy, for it succeeds in pre- 
serving the property of the agent complete, without 
permitting the escape of any of the volatile principles — 
something sure to occur if the agent be dried and stored 
for even a brief space of time. Some agents deteriorate 
materially, even during the short process of drying. In a 
country practice of fourteen years, where indigenous 
remedies were numerous and abundant, I prepared many 
of my medicines in this manner, and was never disap- 
pointed in the effects of a drug thus obtained. 

In gathering plants for medicinal purposes, it should 
be borne in mind that the most vigorous, healthy ones 
should be selected from situations in which they tend to 
grow spontaneously. Wild plants are better than culti- 
vated ones, for they select a spot best adapted to a full 
development of all their qualities. A plant which flour- 
ishes best in a bright, sunny place on dry ground, should 
not be employed if found in a damp, shady spot. Neither 
should they be gathered when wet with rain or dew, but 
under the sunshine, when rays of light are contributing to 
active changes in their tissues. During blossoming-time 
the plant contains the most active qualities. Flowers 
should be gathered as soon as they open; berries, fruits, 
and seeds, when fully ripe; bulbs, as soon as mature, and 
the leaves begin to decay; barks, late in the autumn; 
roots of perennial plants, in the autumn after the leaves 
have fallen, or in the spring before they start ; those from 



THE SCIENCE AND ART OF PRESCRIBING. 1*23 

biennials, in the spring or fall of the second year ; from 
annuals, just before the seeds ripen. 

The great point to be impressed is the necessity of 
caution against the obtaining of a poor agent. When the 
medical profession becomes completely and fully awake 
on this subject — and it is no new one — there will be no 
demand for poor drugs, no opportunity for their substitu- 
tion, and they will not be in the market. But as long as 
a certain class of practitioners administer huge doses of 
crude drugs to their patients, without stopping to inquire 
as to their quality, so long those who follow more of a 
system of refinement in therapeutics must be on their 
guard against unreliable preparations. 

FORM FOR ADMINISTRATION. 

This is an important consideration if we expect success 
to follow our efforts ; for remedies should be taken 
promptly and regularly, in order to fulfill our expecta- 
tions, when we prescribe them. 

Some patients cannot take a pill or capsule, some can 
take a capsule but not a pill, and vice versa; others cannot 
take medicine in solid form at all, and demand that every 
medicine shall be fluid, while others prefer powders. 

Then comes the question of pleasant medicines. The 
agent must be pleasing to the eye, unobjectionable to the 
taste, effective in quality, and somewhat concentrated as 
to quantity of dose. 

Besides these considerations, the physician's conven- 
ience must sometimes be consulted. If he is doing an 
office practice in a city, where himself and patients are 
convenient to numerous pharmacies, he can prescribe or 
administer to suit, perhaps, the caprice of all concerned, 
but if his practice call him far from his office over such 
roads as demand equitation for ready travel, his medi- 
cines, in order that he may carry a variety, must be con- 
centrated, and in such form as to avoid loss or injury to 



124 THE SCIENCE AND ART OF PRESCRIBING. 

oilier contents of his case, if a vial should become un- 
corked or be broken by the jolting. In such an instance, 
solids will be the most desirable form. 

Professor Scudder in his "Specific Medication" recom- 
mends the carrying of fluids (specific medicines), to be 
dispensed in water, a few drops of the appropriate rem- 
edy to be added to half a glass, or four ounces, of the 
vehicle, so that a teaspoonful shall be the regulation dose; 
and this is an admirable form, in acute practice, for a 
large number of remedies may thus be conveniently car- 
ried, — sufficient for an extensive practice, without need of 
frequent refilling. 

Bat in chronic practice, this method has its objections. 
In a warm atmosphere, an organic medicine soon under- 
goes fermentive change when so highly diluted, and in 
order to keep the remedy constantly up to the standard, 
it should be prepared each day. This involves much 
trouble and expense, and soon puts the practitioner to his 
wits to devise a means by which his patient can be sup- 
plied with remedies which will remain in perfect state 
until the entire prescription has been taken. 

Water will still constitute the bulk of the vehicle, if 
the medicine is to be fluid in form, but after the active 
agent or agents, something unobjectionable as a preserv- 
ative must be added. What shall this be, alcohol? No. 
Syrup? No, these are abominations, in the majority of 
cases. 

Glycerine is the best agent for this purpose, from 
twenty-five to fifty per cent of the bulk of the vehicle, ac- 
cording to circumstances, serving to preserve a mixture, 
and often, at the same time, to enhance its effect. Glycer- 
ine possesses rare virtues in the correction of fermentive 
states of the alimentary canal, promoting, as well, normal 
peristaltic action. 

I would recommend then in the prescribing of fluid 



THE SCIENCE AND AET OF PEESCRIBING. 125 

medicines, unless the patient is to be visited daily and 
the remedy as regularly renewed, that such a preserva- 
tive constitute a part of each prescription. 
For example : — 

# Phytolacca (s. m.), f 3ss. 
Glycerine, f 33. 
Water, add to f§iv. 

In the sea-coast atmosphere of California, this formula 
will remain unchanged for a week, though if the tempera- 
ture be considerably higher in other parts than there 
during the summer, the amount of glycerine should be 
increased from one, to two nuidounces. 

Inorganic substances administered in solution, if not 
combined with organic principles will not ferment, and 
need only the solvent ; and if this be simple water, it is 
sufficient. 

Another elegant form for the administration of medi- 
cines is one which commends itself for the reason that 
children, and some adults whose palates are easily of- 
fended by remedies in other forms, receive them kindly, 
while they may, at the same time, represent all the medic- 
inal principles requisite, in a small quantity. I refer to 
triturations. 

Thorough subdivision of the particles of any agent 
without doubt promotes its ready absorption, and the full 
display of its properties. If it be an agent of powerful 
nature, its thorough incorporation with some bland vehi- 
cle is an excellent manner of putting it in shape for con- 
venience and safe dosage, rendering accidental poisoning 
from the pocket-case out of the question. Triturations, 
moreover, are elegant preparations. They may be carried 
without danger of soiling the pocket-case or pocket. 
They are clean, attractive, and pleasant to the taste, and 
in this day, when offense to the palate must be avoided 



126 THE SCIENCE AND ART OF PRESCRIBING. 

as well as disease removed, this is no small matter. Trit- 
urations are convenient for office dispensing, also, and at 
the same time they save much trouble in keeping on hand 
a stock of vials, to say nothing of the expense. 

I do not believe that trituration adds anything to the 
drug in the way of dynamization, except the advantage of 
divisibility. The old homeopathists believed that every 
turn of the pestle imparted a new property to the agent, 
and that it acquired new potency as it was carried higher 
in the scale. But this doctrine has fallen through; is 
scouted by the most earnest and sensible men in the 
homeopathic school. Hahnemann doubtless contained in 
his composition more or less of a tendency to supersti- 
tious credulity — nothing to be wondered at considering 
his time. 

Schussler, in his work on the "Biochemic Treatment of 
Disease," suggests that tissue remedies may be so finely 
subdivided by trituration, as to be taken up by the 
nerve-sheaths of the sympathetic, which ramify through 
the mucous membrane of the mouth and upper part of 
the throat, and, proceeding to the nearest ganglia, distrib- 
uted to the diseased tissues through radiating branches, 
without entering the general circulation, at least a certain 
portion, more rapidly and directly than would be the case 
if first taken into the blood. 

Rejecting all theories as regards any additional prop- 
erty to be derived from the process, except that of conven- 
ience, we may consider this sufficient to warrant the use 
of triturations in a large number of cases, and believe 
those of our readers who are not informed as to the man- 
ner of preparing them should know something about it ; 
for while it may be more satisfactory to purchase them 
from a pharmacist, this is not always convenient, and it 
saves considerable expense to prepare the trituration 
needed, from the potency next below in the scale. Rural 



THE SCIENCE AND AKT OF PRESCRIBING. 127 

practitioners, especially, will find it convenient to be 
fitted to prepare their own triturations, for valuable time 
is sometimes consumed while waiting for the shipment of 
a package from the city, and this class of agents cannot 
be found in many places outside the commercial cen- 
ters. 

I do not believe that mathematical precision is essen- 
tial to the successful use of a trituration. No doubt the 
one-ninety-ninth of a grain of a drug would produce very 
nearly or quite the same effect as the one-hundredth of a 
grain of the same agent; or perhaps the nine hundred 
and ninety-ninth nearly or quite the same effect as the 
one-thousandth. Perhaps too much stress has been laid 
upon these matters, and that this tends to bring ridicule 
upon the whole process. The object being to render the 
dose sufficiently minute to produce the desired effect, 
without disturbing the economy or part unpleasantly, we 
might employ some other scale of division besides the 
centesimal or decimal, but these are convenient, and not 
objectionable to any genuine Eclectic because they have 
been employed by the homeopathists. 

Hahnemann's method of triturating remedies consists, 
in his own words, as follows : — 

"Of the pulverized substance you take one grain; mer- 
cury may be used in the liquid state ; of petroleum you 
take one drop, instead of one grain put this grain; into an 
unglazed porcelain mortar; then you take thirty-three 
grains of sugar of milk and mix them with the drug by 
triturating the- mass with some force for about six min- 
utes by means of a porcelain pestle. Before you tritu- 
rate stir the mass for a little while with a spatula. Hav- 
ing triturated the mass, you stir it again for about four 
minutes, scraping up that part which covers the bottom 
of the porcelain mortar, and also that which adheres to 
the pestle ; then you triturate again with greater force for 



128 THE SCIENCE AND ART OF PRESCRIBING. 

six minutes, without, however, adding anything new. 
This mass jou scrape up again for four minutes, add an- 
other thirty-three grains of sugar of milk, stir the new 
compound for a while with the spatula, then triturate it 
for six minutes ; scrape it up for four minutes ; triturate it 
again with great force for six minutes ; scrap© the mass 
up again for four minutes ; then add the last thirty-three 
grains of sugar of milk, and with this last added portion 
proceed as with the two former. This powder you in- 
close in a well-corked glass, and mark it with the name of 
the substance and the figure 100, to show that this is the 
one-hundredth potency of the drug. " 

Some of the directions here seem needless, technical, 
and even whimsical, and without doubt are unnecessary 
for the preparing of a good trituration. The founder of 
homeopathy wished, probably, to guard against careless 
and slovenly manipulation, and the consequent presence 
of particles of the crude material in the preparation, but 
this can be effected without devoting exactly four minutes 
to stirring and scraping and six minutes to trituration for 
two consecutive periods, after the addition of each third 
of the bulk of sugar of milk. Still, thirty-six minutes is 
not too much time to devote to the preparation of a tritu- 
ration. Less would not insure thorough subdivision and 
incorporation. Where time is plenty an hour might well 
be occupied with each one. 

The decimal scale is the one commonly employed at 
the present day in preparing triturations. One part by 
weight of the crude drug to nine of sugar of milk 
thoroughly triturated, constitutes the first decimal; 
marked thus : lx ; one part of the first to nine of sugar of 
milk, the second decimal, marked thus : 2x ; one part of 
the second to nine of sugar of milk, the third decimal, 
marked thus : 3x ; and so on as high as it is desired to go. 

If the quantity to be triturated was large, it would be 



THE SCIENCE AND ART OF PRESCRIBING. 129 

well to add a third of the sugar of milk at a time, tritu- 
rating after each addition for ten or fifteen minutes, ac- 
cording to the motion of the manipulator. Some persons 
will accomplish more in six minutes than others in fifteen, 
depending upon the amount of energy or the tension of 
the nervous system of the triturator. 

After the first trituration, it is not necessary to weigh 
the ingredients for the higher preparations. These may 
be measured in a small graduated medicine tumbler or in 
a teaspoon near enough for all practical purposes. As 
we have already stated, mathematical precision is not im- 
portant, so that there be something of a uniformity in the 
size of the dose, and it be minute enough to disturb mo- 
lecular action in the diseased organism kindly. 

I would take, then, say a teaspoonful of the trituration 
to be carried up a step in the scale, put it in a clean mor- 
tar and add nine teaspoonfuls of the sugar of milk or 
other vehicle and triturate for thirty or forty minutes, 
scraping the sides of the mortar and the pestle frequently 
during the time ; or, to insure more complete divisibility 
and incorporation, we may add three teaspoonfuls of the 
vehicle to the first spoonful and triturate for a few min- 
utes — ten or fifteen— then again add three teaspoonfuls 
of the vehicle, again triturate, and thus continue until the 
nine have been added. At the end of this time the ques- 
tion will arise, Which insures the best trituration? Solve 
it if you can and take your choice. 

Sugar of milk is the vehicle usually employed for carry- 
ing drugs up through these processes. It possesses 
enough of the cohesive property to render it convenient 
for dispensing, is inert except as regards its nutritive 
properties, which are not objectionable, and pleasant to 
the taste. But sometimes it is not convenient for rural 
practitioners to obtain this article, and some more com- 
mon vehicle must be employed. Cane-sugar would 
9 



130 THE SCIENCE AND ART OF PRESCRIBING 

answer this purpose were it not that it absorbs a modi- 
cum of moisture from the atmosphere, and when the phy- 
sician needs his trituration for use, it may be found ad- 
hered into a firm mass. This objection may be easily 
remedied, however, by the addition of half as much pow- 
dered starch by bulk or weight. Powdered saccharum 
album and culinary or laundry starch are combined in 
these proportions and thoroughly incorporated. To ac- 
complish thorough mixing, the articles may be put into 
the mortar and triturated — thereafter to be placed in a 
jar for future use as a vehicle. 

I would not advise the reader to begin with the crude 
drug and carry it up if he can obtain a lower trituration 
of the desired agent with little trouble. These prepara- 
tions are expensive when purchased at a pharmacy, but 
the accumulation of packages of the different attenuations, 
k> say nothing of the labor, would be enormous if many 
were used and each one were brought up through a num- 
ber of steps. The preferable plan is the purchase of an 
ounce of the trituration next lower than that usually em- 
ployed, and when the supply jar becomes exhausted, it 
can be replenished by carrying a teaspoonful of the lower 
attenuation up one step. 

There is no call for straining a point by devoting a 
mortar and pestle to each drug. Pharmacists would fain 
have us believe that the preparation of these articles 
calls for an expensive paraphernalia. Water, if properly 
and rationally applied, and a clean drying cloth be used, 
will cleanse the single mortar effectively after the prepa- 
ration of each trituration. The mortar and pestle should 
be proportionate in size, the mortar being large enough 
to contain the mixture safe from spilling when the pestle 
is vigorously manipulated. 

Fluid medicines may be triturated by adding a fluid- 
irachm of the liquid to nine of sugar of milk for the first 



THE SCIENCE AND AET OF PRESCRIBING. 131 

and proceeding with the result, as in other instances. 
The first trituration may be pasty at first, but it will 
soon become dry and pulverized, after it has been scraped 
down a few times. Fluid medicines, however, are usually 
attenuated by dilution more satisfactorily than by tritura- 
tion. 

Dilutions are the same class of preparations as tritura- 
tions (attenuations), only they consist of the reduction of 
the active principle in fluid form, alcohol usually consti- 
tuting the vehicle, — the first decimal dilution consisting of 
one part of the remedy to nine parts of alcohol, mixed 
and well shaken ; the second of one part of the first to 
nine of alcohol, well shaken, etc. 

I find some of the specific medicines too concentrated 
to be satisfactorily dispensed to children in the full 
strength, even when largely diluted with water. I have 
known several cases of poisoning in infants with aconite 
administered in this form. Five drops of the specific 
medicine in four ounces of water are amply sufficient for 
an adult if a teaspoonful be given every hour, and if one 
is preparing the mixture for an infant, one drop is fully 
enough; if by accident several drops go over the lip of 
the vial instead, there is danger in the dose. For infants, 
then, and even for general prescribing, the first dilution 
of Lloyd's aconite is preferable to the original form, for 
the same manner of use. The toxic effects of belladonna 
are also often developed from the specific medicine. This 
may be said to its credit, for it demonstrates the sterling- 
quality of the drug; but a much more satisfactory action 
(dynamical), may be obtained from the third dilution. 
Colocynth exhibits all its admirable qualities as a reliever 
of abdominal neurosis, when half a teaspoonful, or less, of 
the third dilution is added to half a glass of water (four 
ounces), and teaspoonful doses are administered; and the 
bitter taste is gone. These, with tincture of phos- 



132 THE SCIENCE AND ART OF PRESCRIBING. 

phorus, nitro-glycerine, tincture of copper, and a few 
others, about comprise the list of specific medicines 
which require dilution, before dispensing after Professor 
Scudder's plan. 

Crude drugs to be administered in solid form may 
now, thanks to one of the triumphs of modern pharmacy, 
be concealed in capsules, so that the most nauseous agent 
may be taken without discomfort, if the patient is able to 
swallow a bolus. Alstonia, quinia, sulphite of sodium, 
solid extracts, etc., may be introduced into capsules, of 
which a number of sizes are manufactured, and thus dis- 
pensed without fear of rejection by the patient, because 
of objectionable taste. These articles are cheap, and 
should be part of the dispensing stock of every physician. 

THE QUESTION OF DOSE. 

This subject has been a much discussed topic during 
many of the past years of medical history. Since the ad- 
vent of Hahnemann, with his attenuations, the medical 
world has been largely divided into two factions, repre- 
senting respectively the large, and the small dose. 

Dynamical therapeutics have little room for the large 
dose. If we desire to antidote a poison, expel a parasite, 
or relieve an excessively painful sensation, we may em- 
ploy medicine in such quantities as to arrest or disturb 
function, for a time, with beneficial effect ; but we cannot 
expect natural processes to be subserved while the agent 
is passing through its active influence in the system. In- 
stead, there is likely to follow more or less debility of 
certain parts principally affected, even though the desired 
result be attained. 

The nature of a drug must determine, to a certain ex- 
tent, its dynamical dose. Some drugs are so powerfully 
toxic in material doses, that therapeutic effect can only be 
expected when minute quantities are administered. Aco- 
nite, bromine, bichromate of potassium, and iodine, may 



THE SCIENCE AND ART OF PRESCRIBING. 133 

be named as examples. Others seem to act equally well 
in attenuations or in crude doses, as, for instance, calcium 
sulphide. 

There is a certain range within which it might be a 
question as to what constituted the proper quantity, and 
we find here the individuality of the physician asserting 
itself. Possibly one physician affords his female patient 
as much benefit in a case of pelvic weight and discomfort 
with the 3x of sepia, as his neighbor does with the lOx, 
and, probably, has no better success. In either case 
there is not enough of the agent exhibited to prove an 
unpleasant disturber, when its specific affinities are mani- 
fested, and in both cases dynamical therapeutic results 
follow. 

Though the question of minute dose continually grows 
more acceptable to a larger number of physicians, there 
is always so much difficulty in accepting the proposition 
of attenuation, — except in the case of born and bred hom- 
eopaths — that a few illustrations may profitably be of- 
fered as to the materialism of highly attenuated medi- 
cines. The microscope under a power of three hundred 
diameters has detected particles of medicine in the 10s 
and llx, in triturations and the spectroscope has done as 
much in case of dilutions 

But let the sceptical one take crude sepia (India ink) t 
and carry it up through the ascending grade, and he needs 
no optical apparatus to convince him of the presence of 
the active agent, after a number of steps have been taken. 
The first trituration representing nine parts of a perfectly 
white substance (sugar of milk), to one of the active 
agent is almost black, the second is brown, and the third 
still affords an unmistakable evidence of the presence of 
coloring material, and, by comparing the fourth with pure 
sugar of milk it needs no logic to convince one that a 
slightly darker tint exists in the trituration, of which one 



134 THE SCIENCE AND ART OF PRESCRIBING. 

ten-thousandth portion only, is represented by the crude 
drug. 

But the human organism is delicately sensitive to the 
action of minute quantities of drugs ; this seems the most 
difficult of comprehension. A minute dose produces no 
change with the healthy person, for the impression made 
is so slight as to be incapable of causing deviations in 
normal processes ; however, in disease, the debilitated or 
disordered functions are nevertheless prompted by such 
quantity, and restoration follows. 

Clinical experience, then, is of more value in the deter- 
mination of dose than all the theory or scientific investi- 
gation that can be made. 

Some persons are extremely susceptible to the action 
of a medicine that can be tolerated by others in much 
larger doses. Many Eclectics use the one-per-cent solu- 
tion of nitro-glycerine habitually, and it does very well 
as a rule, but I have produced severe aggravation of a 
throbbing headache with the 3x, which would represent 
the one tenth per cent; this patient complained of severe 
cerebral throbbing when a teaspoonful of the 5x was 
added to a wineglassful of water, and a teaspoonful given 
every two hours. 

I believe that the majority of fluids requiring attenua- 
tion act as well in the third decimal dilution as higher, 
and I prefer the majority of our indigenous remedies in 
the form of specific medicines, simply diluted in water. 
But certain mineral agents, as arsenic, antimony, mer- 
cury, etc., should not be administered in lower attenua- 
tions than the 2x or 3x, and some animal substances, as 
oyster-shell, act well in high, as well as low, attenuations. 
Lachesis and other serpent poisons should be highly at- 
tenuated. 

Unfortunately, the tendency has been to assume exclu- 
sive positions upon this subject instead oftaking the mid- 
dle ground and recognizing the benefit of both the large 



THE SCIENCE AND ART OE PRESCRIBING. 135 

and the small dose, as demanded by the appropriate oc- 
casion. 

THE SINGLE REMEDY VERSUS COMBINATIONS. 

The practice of administering but one remedy at a time 
possesses its advantages in certain respects, while that 
of combinations may also put in claims for recognition. 
The worst that may be said of either practice, is, that it 
has been abused. No one but the strictest Hahnemaniaii 
adheres to the single remedy usage ; many avowed home- 
opathists not -only alternate single remedies but combine 
them in the same dose as well. 

The use of single drugs does more to develop theit 
clinical properties than combinations, for when benefit 
follows promptly upon the administration of the single 
remedy there can be no question as to what has done the 
work; there is no disputing the fact, that we can thank 
homeopathy for much valuable therapeutic knowledge 
thus obtained. But two drugs may be needed at the 
same time, and may operate in distinctly separate fields^ 
each one accomplishing its special mission, and each one 
being urgently required by the exigencies of the case. 

To illustrate this, let us take a case of acute pharyngi- 
tis : We have here a local inflammatory condition, 
marked by general, as well as local disturbance. The 
general disturbance consists of an acceleration of the 
general blood stream, with increased rate of pulse, 
arrested secretion, headache, nervous irritability, muscu- 
lar pain, etc., calling for a remedy which will specifically 
influence the vaso-motor centers controlling the general 
circulation. Sedation of this general vascular disturb- 
ance is an important indication to fulfill, and one of the 
special sedatives (usually aconite), the appropriate rem- 
edy. But there is a localized area concerned in this case 
which, though influenced along with the general circula- 
tion by the sedatives, is more specifically controlled bj 



136 THE SCIENCE AND ART OF PRESCRIBING. 

a remedy (phytolacca), which does not exert any influence 
over the general circulation. 

In order to derive all the benefit possible from a pre- 
scription, in such a case, then, the two agents must either 
be administered in alternation or combined in the one 
mixture ; and as clinical experience has proven that they 
act as well in combination, it is convenient in many ways 
to unite them. The following combination proves more 
satisfactory than any single agent in such a case: — 
# Aconite (s. m.), gtt. v. 

Phytolacca (s. m.), f3ss. 
Water, add to f ?iv. 

Suppose we take a case of acute mucoenteritis as an- 
other example : Here we have again the general vascular 
disturbance to be met by the appropriate sedative, and 
the local vascular area, amenable to the influence of the 
more specific agent (ipecac), but the element, pain, may be 
so prominent a feature in this case that even a third rem- 
edy more adapted to the neurotic phase may be added 
with advantage, and colocynth can become a helpful 
agent in the combination. Thus : — 

P Aconite (s. m.) gtt. v. 
Ipecac (s. in.), gtt. xv. 
Colocynth (s. in.), gtt. iii. 
Water, add to fjiv. 

The only objection that can be urged against combina- 
tions, unless they are carried into the extreme of empiri- 
cal shot-gun prescribing, is that of incompatibility. Of 
such errors there is little danger, with the small dose and 
specific adaptation of dynamical therapeutics. However, 
a brief notice of this subject is worthy our attention. 

Incompatibility of drugs may be considered under 
three separate heads : (1) Chemical, (2) therapeutical, and 
(3) pharmaceutical. 

Chemical incompatibility may result unfavorably when 



THE SCIENCE AND AET OF PRESCRIBING. 137 

the combined agents react upon each other to form new 
compounds, which may render the active principles either 
insoluble or of such form as to divert the combination 
from its objective point as a therapeutic agent. Phos- 
phoric acid and quinine united in a vehicle form phos- 
phate of quinia, an insoluble compound which becoming- 
precipitated, forms an unsightly mixture, and unless the 
vial be well shaken at each time of taking, the therapeu- 
tic properties are left behind until the contents are 
nearly exhausted, to then appear in exorbitant doses. 
The combination of two salts may result in exchange of 
their radicals and the formation of new salts, when com- 
bined in a solution ; such agents, if more than one be ad- 
ministered at a time, should be given in alternation. 
Acids and chemical bases when united result in the form- 
ation of salts, and should not be joined in a prescription 
unless the preparation of a salt is intended. Borates, 
carbonates, hydrates, phosphates, and tannates of alka- 
loids and minerals, are liable to result if caution and dis- 
crimination be not exercised in the combining of them. 
Lime unites readily with the atoms of carbonic acid of 
many carbonates to form an insoluble precipitate. Other 
examples might be offered but are hardly necessary in a 
work of this character. 

Therapeutic incompatibility implies antagonistic action on 
the part of two agents in the system when administered 
at the same time, though there may be no chemical in- 
compatibility prior to administration. Certain drugs 
interfere with- the action of certain others without doubt. 
Atropia and sulphate of morphia are antagonistic, the one 
autidoting the action of the other, a fact worthy of recog- 
nition in case of poisoning by either agent. Calabar 
bean and belladonna, and jaborandi and belladonna are 
other instances. It has been asserted by some that the 
prescribing of belladonna and gelseminum at the same 



138 THE SCIENCE AND ART OF PRESCRIBING. 

time is unscientific, for the reason that they are indicated 
in opposite states of circulatory disturbance. But while 
there are few cases where both remedies would be indi- 
cated at the same time, the fact that each remedy, so far 
as the circulation is concerned, spends its therapeutic 
force upon a different part — each acting in a different Hue, 
the one upon the heart and arteries, the other upon the 
capillaries, would go to gainsay such a proposition. Gel- 
seminum is usually indicated in sthenia, with full, bounding 
pulse; belladonna in asthenia, with feeble, compressible 
pulse ; but this need not indicate that the one would anti- 
dote the influence of the other if both were administered 
at once. 

A general knowledge of the physiological action of 
drugs — an important need in the education of every ther- 
apeutist, will usually enable the practitioner to avoid 
therapeutic incompatibles. 

Pharmaceutical incompatibility will not trouble us much, 
as we do not propose to deal largely with polypharmacy. 
Mixtures of iron and vegetable extracts result in inky 
compounds, formed by the precipitation of tannates. Io- 
dide of potassium decomposes many — in fact nearly all 
metallic salts, — and corrosive sublimate is decomposed by 
association with almost any other agent (a fact not highly 
important here, but mentioned incidentally). Certain 
agents are poAverful oxidizers, as chlorate of potassium, 
nitric, and nitro-hydrochloric acids. Sugar, the oils, 
ethers, phosphorus, and glycerine, being readily oxidiza- 
ble, should not be indiscriminately mixed with such 
substances for fear of an explosion, to say the least. Al- 
most every physician's visiting list contains a catalogue 
of incompatibles, which will be found valuable for study 
during spare moments, if his predilections are in the di- 
rection of indiscriminate mixing 

There are often instances where the single agent acts 



THE SCIENCE AND AKT OF PRESCRIBING. 139 

with more positiveness than if combined with another. 
Given, a case of laryngeal irritation with hoarseness as a 
leading characteristic, and potassium bichromate 2x or 3x, 
acts more promptly than any combination can, in effecting 
a cure. Given, a case of spasmodic cough, especially per- 
tussis, and drosera excels the most approved combination. 
Given, a case of capillary bronchitis, with subcrepitant 
ronchi, and suffocative cough, with evident oppression of 
the respiratory center, and tartar emetic 2x will produce 
more prompt and pleasing effect than all combinations 
ever tried. 

In conclusion, then, it may be written, that two or 
three remedies may be advantageously combined when 
there is offered for each, in a given case, a separate field 
for action. When such fields are not offered, the single 
remedy will be more scientific and more satisfactory. 

It may be added, that, as a general rule, no combina- 
tion should contain more than one mineral agent, if in- 
tended for internal administration. It would be better 
to make it a rule to always administer mineral agents 
singly, and in alternation with other remedies, if the case 
calls for any further medication. 

TIME OF ADMINISTRATION. 

The time of administering medicines is worthy a few 
moments' thought, for in some cases it is of considerable 
importance. For instance : Vermifuge agents may en- 
tirely fail of the desired effect if taken while the stomach 
contains food, or immediately before eating; an antiperi- 
odic administered so that its effect has passed off before 
the time of exacerbation affords unsatisfactory results, 
failing, usually, to interrupt the periodicity. Some rem- 
edies prove irritating to the stomach when taken before 
meals or when the organ is empty, and require to be 
taken after meals ; such is the case with cod-liver oil, al- 
stonia, and some other remedies. 



140 THE SCIENCE AND ART OF PRESCRIBING. 

The administration of minute doses of medicine, in 
acute disease (and this is usually the preferable plan), 
comprehends a frequent repetition of the dose. The sed- 
ative mixtures of aconite, gelseminum, veratrum, jabo- 
randi, etc., (a few drops of the remedy in four fluid-ounces 
of water, the dose being a teaspoonful), should be admin- 
istered every hour to maintain a constant influence over 
the circulation and eventually bring it under control. 
Minute doses of ipecac, lobelia, nitrate of sanguinarina, 
tartar emetic, etc., administered to control pulmonary ir- 
ritation giving rise to cough, should be taken every two 
hours, at the most, for the philosophy of the small dose 
is its direct action continually impressed, against that of 
the large dose, spasmodically disturbing a part in an un- 
pleasant manner. 

In chronic disease, even when we rely upon the minute 
dose, frequency of repetition is not so important ; intersti- 
tial changes do not require such frequent prompting as 
circulatory changes, or, perhaps, it might be better stated 
that drugs which specifically impress interstitial or cel- 
lular changes are not so speedy in action nor so evanes- 
cent in their influence, as those which are^adapted to dis- 
turbances of the circulatory system. 

In chronic disease, then, three or four doses in twenty- 
four hours answer as good, if not a better purpose, than 
more frequent repetition. The therapeutic effect in 
chronic disease must be the gently persuasive, not the 
radically coerceive one. 

PRESCRIPTION WRITING. 

The wise physician will dispense his own medicines, as 
a general rule. However, there will occur numerous 
instances in which it will be more convenient to send the 
patient to the druggist, and the observance of a certain 
decency in the matter of inditing the billet which calls for 
the remedy or formula required, is worthy of observance. 



THE SCIENCE AND ART OF PRESCRIBING. 141 

There are numerous reasons why a prescription should 
be unintelligible to certain patients. Could we always 
deal with educated and intelligent persons, it might be 
different, but with many, a common remedy called for by 
its common name would not be considered worth the tak- 
ing, or a remedy which is poisonous in large doses, if 
prescribed even in highly attenuated ones, would be suf- 
ficient to frighten some into discarding their physician 
for prescribing such an agent ; therefore it would be better 
to disguise a knowledge of the character of such med- 
icine from the patient. 

A few physicians pride themselves upon their dog- 
Latin — for few employ anything better than a mere smat- 
tering of knowledge of the Latin language, — and make 
it a point to criticize and ridicule the prescriptions of 
less pretentious competitors, who perhaps may excel 
them in the real science of therapeutics. This is an ad- 
ditional reason why prescription writing should receive 
some attention from every practitioner, even though he 
may not practice polypharmacy, or follow the habit of 
sending every patient to the druggist for a bottle of 
nauseous compound. 

Physicians who write faultlessly correct Latin prescrip- 
tions are few, and far between. Latin is a study demand- 
ing a great deal of close application for its complete 
mastery. Its numerous complicated declensions and con- 
jugations, with their rules and exceptions, are calculated 
to muddle the brains of those who do not devote much 
labor to them. The majority of pretended Latin pre- 
scribes might find it difficult to write even a correct 
English prescription, and if they possess a little knowl- 
edge of some of the rudiments of Lati$ they are among 
the favored few; but the majority are liable to many 
stumbles and blunders which, if their work were criticised 
by competent judges, would readily appear. 



142 THE SCIENCE AND ART OF PRESCRIBING. 

Modern prescription writing has established the cus- 
tom of semi- Anglicising and abbreviating, so that many- 
tough problems are slidden over with a tolerable show 
of scholarly skill ; and this is all very well, for why should 
a dead language be prepetuated at needless expenditure 
of labor, when medicine presents so many more-important 
subjects, to demand unceasing application for their suc- 
cessful study? 

Every prescription may be divided into four parts : (1) 
The superscription ; (2), the inscription ; (3) the subscription ; 
and (4) the signature. In some cases the subscription is 
joined to the inscription so that these parts are not dis- 
tinctly set forth An illustration of this deviation will be 
given shortly. 

The superscription universally employed is the symbol # 
(which is not an abbreviation and requires no period). It 
is formed from the union of the first letter of the Latin 
verb Becipio and the sign Jf (used as an invocation to a 
supernatural power by the ancients). This occupies the 
left hand corner of the prescription and literally signifies 
Becipe, the imperative mood, second person, singular 
number, of Becipio (I take), and literally signifies, "Do 
thou take. " It is directed to the one who compounds the 
mixture. 

The insertion consists of the body of the prescription, 
containing the names of the ingredients, and the amount 
to be employed of each, in drops or grains, drachms, etc. 

The subscription indicates the form the mixture is to 
assume; as, if the ingredients are fluid, the abbreviation, 
M. If the ingredients are solid and in the form of 
powder, the abbreviations M., ft., chart., no., etc., indica- 
ting the number tff powders or papers the mixture is divi- 
ded into, are employed. 

The signature contains the directions with regard to the 
administration of the medicine, and the prescriber's name. 



THE SCIENCE AXD AET OF PEESCEEBING. 143 

It is preceded by the abbreviation S. or Sig., which sig- 
nifies literally, "Yv'rite thou." — the writing to be done 
upon the label of the vial or wrapper containing the med- 
icine after it has been compounded. 
For example: — 

Superscription. # 

T . ,. \ Qninise sulph., gr. xv. 

Inscription. < /?, , . l ' s 

1 \ (j-lycyrrnizse, pulv., gr. xxx. 

i M. (or Misce, Mix), et ft. (or flat), 
Subscription. •< pulveres numero xv (and make fif- 

( teen powders). 

( S. (Sig., or Signa). — Take a pow- 
Signature. -2 der before each meal. 

( John Doe, M. D. 

The combination of the inscription and subscription 
may be illustrated as follows: — 

Superscription. $ 

Inscription and J Piscidise erythrinse (s. m.), f ji. 

subscription, j Glycerini, q. s. ad f xii. 

( S. — Take a teaspoonful every two 
Signature. < hours until sleep follows. 

( A. Watson, M. D. 

The abbreviation, M., is not needed here, for the rea- 
son that q. s. ad signifies that the last ingredient, glycer- 
ine, is to be added to what has already been prepared, in 
sufficient quantity to increase the bulk of the mixture to 
the amount required; and will constitute the order to mix, 
without further directions. 

A little knowledge of the relationship between the 
nominative and genitive cases, through the various de- 
clensions, will enable one to do tolerably correct work in 
Latinizing his prescriptions, if it be remembered that fy is 
the sign of a transitive verb, and that the amounts of in- 
gredients are its objects ; as, Take of sulphate of quinia, 



144 THE SCIENCE AND ART OF PRESCRIBING. 

fifteen grains, and that the name of the ingredient is in the 
genitive (of sulphate of qninia). 

The genitive case, then, is the only point in which a 
knowledge of Latin is really essential, in order that the 
writer may pass muster as a skillful prescription writer, 
and the five different declensions should be studied for a 
knowledge of the proper use of this case, which is indi- 
cated by the letters in the termination of the name in 
question. 

For example : In the first declension the nominative 
singular ends in a, and the genitive is formed by sup- 
planting the final letter with se ; as, nominative cimcif uga, 
genitive cimcifugce. The word cimcifuga, then, mentioned 
in a prescription after the sign $, should be so written. 
Quinia should be written quiniae, morphia, morphise, etc. 

But when we apply this case ending to the large num- 
ber of agents in the materia medica through the five de- 
clensions with their different classes, it becomes a subject 
of no little magnitude, and evident that it must be made a 
technical matter ; i, e, each agent liable to be included in 
a prescription must be studied with reference to its end- 
ing in the genitive singular, and memorized. This can 
soon be accomplished by one who desires to appear class- 
ical; and, as there is no call for a Latin signature, when 
this is attained the physician is pretty well equipped to 
write Latin prescriptions. 

To this however should be added a familiarity with the 
abbreviations commonly in use, a list of which can be 
found in every medical dictionary. 

A clever maneuver adopted by many prescribers, who 
are not certain as to terminations, is that of abbreviating 
in such a way that there need be no mistaking the agents 
referred to by the writer, and yet so that no case endings 
appear — the final syllable, or perhaps more of the word, 
being supplied by a period. 



THE SCIENCE AND ART OF PRESCRIBING. 145 

Such a prescription as the following one would pass 
as a fair production, and the writer would not commit 
himself upon doubtful points, if he were not a Latin 
scholar : — 

# Cimicif. rac. (s. m.) f 3L 
Pulsatil. (s. m.) f3ss. 
Aq. q. s. ad f jiv. 

But the abbreviating of medical terms requires some 
care, in order that non-professional persons may not ri- 
diculously and disastrously mistake the meaning. The 
account of the physician who was summarily dismissed 
for prescribing "Fl. ex. rham. cat." (cascara) for a suscep- 
tible lady is probably fanciful, but it serves to illustrate 
the danger of recklessness in this particular — for the phy- 
sician's prescriptions are often scanned by curious pa- 
tients. 

After all, it is as well to adopt the plan of writing the 
names of the ingredients in plain English, after the regu- 
lar superscription, entirely foregoing the effort to Latin- 
ize ; at least this might avert many embarrassing situa- 
tions. For example: — 

fy Sulphate of quinia, gr. 15. 
Powd. Glycyrrhiza, gr. 30. 
M., etc. 

Yfith many, the use of Arabic numerals has succeeded 
the more common custom of employing Roman characters 
to designate amounts of ingredients to be employed, and 
the numbers are not so apt to be mistaken when not 
plainly written. 

The metric system of designating amounts of ingredi- 
ents in prescriptions is worthy of passing notice as a nov- 
elty, only. Could any good result from this attempted 
innovation there might be some excuse for the proposed 
departure. Even were this considerable, it could hardly 
compensate for the confusion and accident, liable to at- 
10 






146 THE SCIENCE AND ART OF PRESCRIBING. 

tend the transition. The popular and generally employed 
system serves every purpose, and will probably remain 
in use. 

Plainness of execution is an important element of good 
prescription writing. The efficacy of the remedy or com- 
bination will depend upon the proper or relative amounts 
of ingredients employed ; the safety of the patient de- 
mands that great care shall be exercised when material 
doses of aconite, arsenic, belladonna, colocynth, digitalis, 
phosphorus, strychnia, and other powerful drugs are pre- 
scribed. 

INFUSIONS AND DECOCTIONS. 

This subject should have been included under "Forms 
for Administration," but was overlooked. 

Water extracts 'the virtues of some organic remedies 
better than any other menstruum, and when this is the 
case, preference should be given, either to an infusion or 
decoction, even though the form may not be quite so ele- 
gant as some others. 

Infusions are made by immersing the crude product in 
hot or cold water, for a time ; decoctions, by allowing the 
water to boil. In some cases the process of boiling in- 
jures the medicinal principles, while in others it is essen- 
tial, to extract the virtue required. 

Some of our indigenous remedies are nearly worthless 
for certain purposes, except when water is used to extract 
their virtues, though when such plan is resorted to they 
may occupy the highest place as restoratives. The phe- 
nomenal success achieved by the early Botanies was due, 
largely, to the fact that their remedies were adminis- 
tered in the form of "teas" prepared from recent indige- 
nous plants. 

Erigeron canadensis is an exceptionally valuable rem- 
edy for arresting the alarmingly exhaustive watery evac- 
uations peculiar to some of the active stages of cholera 



THE SCIENCE AND AET OF PKESCEIBING. 147 

infantum, if a decoction of the fresh plant be drank freely, 
but is comparatively worthless in any other form, for 
this purpose. Professor Howe's prescription of logwood 
for diarrhea stipulates that an infusion of the aqueous ex- 
tract must be employed. A decoction of recent root of 
cimicifuga excels all other forms of this agent in mus- 
cular rheumatism. I often turn from more elegant forms, 
back to this primitive one, resorted to for convenience 
and economy during an early country practice, to find 
a waning faith in an old-time remedy renewed. And so 
with a number of other common indigenous remedies. 

Professor J. U. Lloyd, senior member of the firm sup- 
plying "specific medicines," entertains views very similar 
to these, and views which entitle him to the highest re- 
spect for his unselfish candor, when his own interests 
would be better served by indorsing, unreservedly, the 
products of the laboratory. 

But valuable as these forms are, they should only be 
resorted to upon exceptional occasions (when more ele- 
gant forms will not suffice), as the dose must be bulky and 
often nauseatiug, while the practice (unless the manner of 
preparation be kept from the patient) is liable to inspire 
a lack of confidence on account of its apparent crudity. 



; 



148 THE MEDICINE CASE, 



THE MEDICINE CASE. 

The arrangement of a medicine case adapted to emer- 
gencies and every-day needs, is a subject of grave impor- 
tance to the recent graduate. What shall he carry with 
him in order to be prepared to minister to the wants of 
a variety of cases liable to be met with during his daily 
rounds? 

This is a question not to be dealt with lightly. It 
would be an easy matter to provide pretty well for 
every case likely to be encountered in a large practice 
in both acute and chronic cases, were there no incon- 
veniences to be avoided in the way of bulky, heavy 
medicine chest, filled with a large assortment of vials 
and packages, many of them seldom used, liable to be 
broken, and subject to more or less leakage to result in 
gummy coatings for the adhesion of powders, dust and 
other accumulations, to say nothing of the odors em- 
anating to render the whole outfit a nuisance. It is one 
thing to be provided with necessary drugs, and another 
to have them so disposed as to present an agreeable and 
inviting appearance to the patient, and not be a cause of 
offense to the practitioner himself. The filling of a medi- 
cine case in the start is a small part of the affair. The 
outfit must be overhauled, cleaned, the vials refilled, 
wiped, newly corked, and re-labeled every few days, if 
complete justice is done the subject. Really the medi- 
cine case in some respects is a great nuisance, and it is 
no wonder that many city physicians are so ready to 
relegate the entire management of the drug question to 
the druggist, and content themselves with prescription 
pads and pencils. 

But the rural practitioner must carry his own medi- 
cines; drug stores are not always at convenient hand in 



THE MEDICINE CASE. 149 

thinly populated districts, and provision must be made 
for his urgent demands. It is advantageous in many re- 
spects for the city physician to have with him a few of 
the essential remedies while on his daily rounds; let him, 
however, dispense with those likely to be needed but 
seldom, as he can usually provide himself with these at 
leisure, or in advance, as when forewarned by the pres- 
ence in his neighborhood of an epidemic or endemic out- 
break calling for some special agent. The fewer the 
remedies that can be selected for daily transportation 
and the combination prove efficacious, the better. 

It may be safely asserted that there is no call for the 
carrying, habitually, of remedies for the treatment of 
chronic cases; these can be supplied to order and thus 
lessen the bulk and aviordupois of the every-day outfit. 
In acute diseases the remedies in the case can be varied 
to suit the season of the year, or any particular epidemic 
which may prevail. And now let us see what shall be 
supplied in the beginning. 

Febrile and inflammatory conditions are so common in 
acute diseases that the list of sedatives is suggested in 
the start — remedies influencing the circulatory system. 
These are Aconite, Belladonna, Gelseminum, Jaborandi, 
Rhus Tox., and Yeratrum. But here are six remedies — 
a sufficient number of the first class considered to go 
quite a long way toward filling a respectable medicine 
case, and we must try to drop some of them — at least 
leave them on the shelves for occasional resort when 
absolutely indispensable or preferable to the more com- 
monly useful ones ; let us consider them in detail : — 

Aconite. — Aconite is first on the list and a remedy ap- 
plicable to a wide range of cases. It is a sedative in 
fever and inflammation, a calmative in restlessness, a 
pain reliever in rheumatic and neuralgic complaints, and 
it specifically influences irritation of the larynx, pharynx, 



150 THE MEDICINE CASE. 

and intestinal tract, if the vascular areas concerned are 
acutely disturbed. It is what the homeopathists would 
term, "a polychrest". It is an indispensable agent, es- 
pecially valuable as the children's remedy, while it could 
hardly be spared in the adult class, and it is a remedy to 
be employed in all seasons and in almost all acute affec- 
tions. We will fill the first vial then with aconite, the 
first decimal dilution of the specific medicine being pref- 
erable to the full strength, as in dispensing it to very 
small children one drop too many of the stronger prep- 
aration in a glass of water might prove a grave mistake. 

Belladonna. — Belladonna is the next remedy on the list, 
and one fulfilling important purposes when indicated, but 
one, after all, only needed in isolated cases, and at long 
intervals. In a large practice not more than one or two 
cases requiring belladonna are liable to be encountered 
in a year, and that amount of use hardly warrants the 
constant lugging of the remedy, especially as the cases 
are not those demanding great haste as to its administra- 
tion. Belladonna cases border on the line of chronicity. 

Gelseminum. — The next remedy to be considered pos- 
sesses more claims to a place in the medicine case than 
the one just mentioned. Though not indispensable as a 
sedative, its action in determination of blood is \ T ery ac- 
ceptable in many cases ; yet this action is probably as 
well represented by jaborandi. Still gelseminum pos- 
sesses some antimalarial properties and abets the action 
of quinia in many cases, and is probably as positive an 
agent as any we have to assist the relaxation of a rigid 
os uteri. After all has been said however gelsemiuuin 
hardly offers any advantage in any respect over jaborandi, 
and we may leave it out feeling that its place will bo well 
supplied by agents more important in other directions. 

Jaborandi. — We next come to consider jaborandi, as im- 
portant a remedy as aconite, and as indispensable to a 



THE MEDICINE CASE. 151 

satisfactory practice. It is a more positive sedative than 
gelseminum or veratrum, and as sure an antispasmodic as 
gelseminum or lobelia. It is applicable in appropriate 
doses to almost any febrile or inflammatory condition, 
and full doses will relieve the agonizing pain of angina 
pectoris, inflammatory rheumatism, or muscular spasm, 
more promptly, effectively, and safely, than any other 
remedy. It enjoys the reputation in old-school quarters 
of being a specific in erysipelas, one doubtfully earned as 
yet, perhaps, but one worthy of remembrance for future 
trial, while in that dire disease known as cerebro-spinal 
meningitis it has no equal. In any febrile or painful con- 
dition where a dry skin is persistently present we need 
this remedy especially, but it is not contra-indicated if 
this symptom be not prominent. The only preparation 
of this drug that I can recommend from personal knowl- 
edge is the specific medicine. Twenty or thirty drops 
of this constitute a full dose, and two full doses within 
half an hour should be the limit of full doses, where 
there is severe pain. A dram to four ounces of water 
will constitute a fair sedative mixture for ordinary cases 
in teaspoonful doses. This may follow the administra- 
tion of full doses for the relief of pain of inflammatory 
nature, or may be used for the ordinary purposes of a 
sedative. We will fill the second vial with specific medi- 
cine of jaborandi, feeling that with it and aconite we are 
pretty well equipped with sedatives, while we have a 
brace of remedies of quite a wide range of use outside 
the strict limits of vascular therapeutics. 

Blms Tox. — Does this agent fulfill any indications not 
covered in common by other members of the group? I 
think it does. Many febrile states are attended by 
persistent gastric irritability, which interferes with the 
action of other sedatives. Here the tongue is pointed 
with papillae elevated, reddened at the tip, and tremu- 



152 THE MEDICINE CASE. 

lous on protrusion, while there is an unpleasant nausea 
present. These cases usually offer the characteristic 
rhus tox. pulse. Whether they do or not rhus is the 
sedative to combine with aconite until all evidence of 
gastric irritation has passed away. Rhus is the cor- 
rective to use on that border-line where febrile cases 
merge into typhoid conditions. It is the remedy to 
arrest that tendency to blood depravation which later 
must be met by baptisia — indications, extreme restless- 
ness with partial delirium. It nips many a case of con- 
tinued fever in the bud when properly adapted, and is 
valuable when indicated, in cholera infantum and other 
acute diseases of children. Combined with aconite, it 
arrests cholera morbus at once ; here small doses should 
be given every few minutes, until the vomiting and 
cramps cease. We will fill the third vial with specific 
medicine of rhus tox.; ten drops of this in four ounces of 
water, dose a teaspoonful every hour, or oftener. 

Veratrum. — Then comes veratrum. Is this remedy 
worth the trouble of carrying to the bedside of every 
patient lest it be required at a moment's notice? I 
think not. The principal point of commendation for 
veratrum over other sedatives is its value in pneumonia, 
inflammation of the lung tissues ; and here we have a 
more positive agent in asclepias. During a pneumonia 
season veratrum might be substituted for some other 
remedy in the case, for a time, but it will not be re- 
quired often enough to warrant every-day carriage. Even 
in pneumonia, where it has been so highly lauded in some 
quarters, jaborandi and asclepias combined are far su- 
perior, in a majority of cases. 

After the sedatives we ought to consider another class 
of remedies very nearly allied, namely, those which will 
correct blood depravation consequent upon febrile action, 
the antizymotics or antiseptics. These are baptisia, ech- 



THE MEDICINE CASE. 153 

inacea, hydrochloric acid, rims tox., sulphite of sodium j 
and sulphurous acid. What are the experiences of old 
practitioners with regard to the frequency of need of 
these agents ? I believe I voice the sentiments of a 
majority of those who have had much experience when 
I assert, that with the exception of rhus, which has al- 
ready been adopted, in this climate the only one fre- 
quently called for is the sulphite of sodium. The 
others are indispensable when indicated, but are so sel- 
dom needed that it would be better to have them ready 
in the office for resort when required than to burden 
oneself with them unnecessarily. 

Sulphite of Sodium. — This remedy then will occupy the 
fourth place. It is indicated in any case where the 
tongue presents the pasty-white coating, and on the Pa- 
cific Coast this symptom is not an uncommon one. I 
usually administer it in small capsules, one or two grains, 
every four or six hours. Nothing can well be imagined 
more unpleasant to the taste than a solution of this agent 
in water. I was once dismissed from a case on the 
strength of a sodium sulphite solution. The patient be- 
came disgusted with both medicine and doctor. Let the 
remedy be concealed in capsules and carried in the vial 
for immediate use. 

The heart and lungs may next be thought of and the 
remedies likely to be used frequently in that direction 
provided. Such an intimate relationship exits between 
the functions of the heart and the pulmonary circulation 
that the remedies needed here will be somewhat in com- 
mon. Among these is aspidosperma quebracho, one 
not infrequently needed where want of cardiac power is 
attended by difficult, labored respiration. I find the 
symptom sufficiently often in my rounds to warrant the 
carrying of a vial of this remedy. 

Quebracho. — This will constitute the fifth remedy, the 



154 THE MEDICINE CASE. .. 

fluid extract of Parke Davis & Co., usually serving a good 
purpose. 

Cereus Bonplandil — This remedy will supply the sixth 
place. It is a more prompt and efficacious remedy to 
improve the power of the heart than digitalis, and in 
irregularities consequent upon reflex disturbances it sup- 
plies a better purpose. 

The list of cardiac remedies is large and we cannot 
expect to cover a great deal of ground with two agents, 
but, with jaborandi for severe pains here, and those 
named, we have a respectable outfit for a large per cent 
of the cases met with in general practice. And as Pul- 
satilla will be carried as a uterine and ovarian remedy, 
resort may be had here in nervous excitability of the 
heart and in imaginary cases or those where cerebral 
centers are more disturbed than cardiac function, as 
marked by "fear of impending danger". 

The vascular area in the lungs supplied by the bron- 
chial arteries, demands a special class of remedies. It is 
here that veratrum finds its best place and here that we 
derive great benefit from asclepias. Then the respiratory 
membrane supplied from this source demands a number 
of remedies. The special sedatives, aconite, rhus, and 
jaborandi come in here splendidly in acute inflammatory 
conditions, even to the result of acting well as cough 
remedies. But after the first stage is passed something 
more special is demanded. Then ipecac and tartar 
emetic, or lobelia, should be employed. 

Asclepias. — This then will fill the seventh vial to serve 
as a reliance in hyperemic conditions of the lung-paren- 
chyma and to combine or alternate with the sedatives in 
pneumonia. We will use the specific medicine in five to 
ten drop doses every two or three hours, as required. 

Ipecac. — Ipecac supplies the place of a bronchial 
remedy, relieving subacute inflammation of the respir- 



THE MEDICINE CASE. 155 

atorj membrane and curing cough with expectoration, 
where the bronchial tubes remain irritated, after the 
active stage of irritation has passed off. As a remedy to 
relieve intestinal irritation both in children and adults, 
it is one of the most effective, being almost indispensable 
in cholera infantum and dysentery. The specific medi- 
cine serves the best purpose ; from five to twenty drops 
in four ounces of water, teaspoonful doses being admin- 
istered every one or two hours according to age and cir- 
cumstances. We will fill the eighth place with specific 
medicine ipecac. 

Tartar Emetic. — This remedy is valuable in coughs at- 
tended by subcrepitant sounds — subacute inflammation 
of the smaller bronchi. It is the specific remedy for 
the influencing of the resi^iratory membrane in this por- 
tion of the tract. The condition is familiarly known as 
"capillary bronchitis", and tartar emetic cures here as 
promptly as any specific could. As a remedy in asthma, 
it serves a good purpose for temporary relief at least. 
I employ the second decimal trituration, as less liability 
of overdoing the dose is thus present than when the 
crude article is carried, administering two or three grains 
every two hours to adults, but for infants and small 
children, using three grains in half a glass of water, or- 
dering a teaspoonful at a dose. The ninth vial will be 
filled with this agent. 

A number of other remedies might be selected for 
their influence upon the respiratory mucous membrane, 
but we are now trying to avoid cumbering the overworked 
practitioner, and will let these suffice, for the present. 

The alimentary canal next demands attention. Begin- 
ning with the pharynx we have the one remedy for acute 
inflammation of this part and the fauces, — a very common 
complaint — in phytolacca. For the stomach we have 
aconite, ipecac and rhus — remedies already adopted, for 



156 THE MEDICINE CASE. 

irritation and nausea, cimicifuga and colocynth for painful 
conditions of the organ involving the nervous and mus- 
cular structures, aconite and ipecac for irritation of the 
small intestine, colocynth for abdominal neurosis, polym- 
nia for fullnes of the gastric capillaries, chionanthus for 
torpor of the biliary cells, and chelidonium for sub- 
acute inflammatory states of the hepatic structures. 
Then we have collinsonia for congestive conditions of 
the vascular supply to the pelvis, especially the hemor- 
rhoidal plexus. 

Phytolacca. — Phytolacca will be the tenth remedy 
chosen, an indispensable agent for the cure of a large 
number of cases of sore throat. Combined with aconite 
^ve will prescribe it almost every day in the year, and 
derive prompt and satisfactory results. The specific 
medicine is better than any other preparation except 
one made by covering the green root with alcohol. The 
best preparation I have ever used was thus evolved. A 
dram of this in four ounces of water with five or six 
drops of aconite (for the adult) is the prescription for a 
non-malignant, acutely inflamed throat. Additional rec- 
ommendations are its almost positive success in puer- 
peral mastitis and its action in bronchocele and lymph- 
angitis. Though slow, it is one of our most reliable 
remedies in goitre. 

Polymnia. — The vascular area described by the dis- 
tribution of the coeliac axis is particularly the specific 
field of action for this agent. Subacute inflammatory 
conditions and hyperemic states generally, of parts sup- 
plied from this source, especially by the gastric branches, 
demand it. Many unpleasant cases of ^dyspepsia of pain- 
ful character are relieved by the use of small doses of 
polymnia through this influence. The well known action 
of polymnia [on the spleen would also confirm its selec- 
tion, though here we would not need it sufficiently often 



THE MEDICINE CASE. 157 

to justify its admission to a limited list of remedies for 
every-day use. We will choose this agent for number 
eleven. Carduus marianus, ceanothus Americanus, and 
grindelia squarrosa, belong to the same group, and one 
of them might be chosen instead of polymnia. As a 
gastric remedy, however, I consider the one last named 
the first to choose. The specific medicine is the form 
I commonly use. 

Chionanthus. — Professor Goss' well known hepatic agent 
cannot be dispensed with. People, especially patients, 
still possess livers, and something mild but certain, to 
improve the biliary functions is a desideratum. This de- 
mand is supplied by chionanthus better than by any other 
single remedy we possess, and it is not the one to be- 
tray our confidence when this confidence is rationally 
placed. The twelfth remedy will be a vial of the specific 
medicine chionanthus. 

Chelidonium. — This agent is specially indicated in 
hepatic colic where the pain is inflammatory in char- 
acter, and involves the capillaries of the hepatic artery. 
It will abort hepatic abscess if begun in time and the 
patient has not been too heroically dosed with mercury. 
Catarrhal inflammation of the biliary ducts also yields 
to this agent. Let this be number thirteen. 

Colocynth. — A medicine case would not be fitted without 
a vial of colocynth. It is j as important a remedy as 
aconite or jaborandi. It so completely covers the ground 
of neuralgic pain in the abdomen, — abdominal neurosis 
— that it applies to the smallest infant or the oldest 
adult, and every age between. We will prescribe it almost 
daily, and will find it one of the most specific of specifics. 
Neuralgic, intermittent abdominal pain of any character, 
whatever organ is involved, — stomach, spleen, liver, or 
intestines, is amenable to its influence. It not only 
relieves the pains of dysentery but alone often cures. 



158 THE MEDICINE CASE. 

Infantile colic is readily relieved by minute doses of it. 
Evidently we cannot get along without this remedy and 
will fill the fourteenth place with it, the 2x or 3x dilution 
being strong enough, considering its extreme bitterness. 
The dose of this may vary from two or three drops for 
infants in four ounces of water, dose a teaspoonful, to a 
teaspoonful in the same amount of water when prescrib- 
ing for adults. 

Collinsonia. — This remedy completes the list of drugs 
devoted to the alimentary canal. We might make it 
larger but have encompassed considerable with a small 
number, and that is the object when filling a medicine 
case. Collinsonia will be held in reserve for its influ- 
ence upon the lower bowel, hemorrhoidal conditions be- 
ing its principal field of usefulness. Hypogastric pain 
if emanating from disturbances of the alimentary canal 
also disappears before its influence, and it has proven 
effective in dysentery, especially for the pains, when lo- 
cated lower down. Hemorrhoidal states are favorably 
influenced by other remedies but where only one is car- 
ried this will be the first choice. 

One point to be emphasized here is that the prepara- 
tion must be from the plant, and not the root. The root 
is employed in the preparation of the specific medicine. 
Careful trial and observation have convinced me that a 
tincture of the green plant (leaves, blossoms, and stems,) 
is much superior as an agent to influence the pelvic 
viscera. The homeopathic mother tincture is thus pre- 
pared. While practicing in Ohio I made my own tinc- 
ture from the plant freshly gathered, and always obtained 
the best of results. We will fill the fifteenth vial with 
green plant tincture of collinsonia. Of this from one 
to ten drops may be prescribed at a dose for an adult. 

And now we must add a few remedies for the repro- 
ductive apparatus — applicable to both sexes. We will 
only choose three as we will be able to get along with 



THE MEDICINE CASE. 159 

these very well in acute practice — macro tys, pulsatilla, 
and sabal serrulata. 

Pulsatilla. — This remedy will come in play for the re- 
lief of unpleasant sensations in the female pelvis during 
pregnancy, for uterine colic, for dysmenorrhea and neu- 
ralgia. "Nervousness" due to sexual disturbances also 
calls for pulsatilla. It is the woman's remedy in a thou- 
sand different unpleasant states, while it has been highly 
lauded as a remedy for coughs and gastric disturbances. 
Orchitis and orchialgia also call for it, and we find there- 
fore a place for it in the treatment of disturbances of the 
reproductive apparatus in both sexes. The German 
tincture, made from the green plant, is sold as specific 
medicine, and also kept at homeopathic pharmacies un- 
der the name, -'Mother Tincture". We will fill the 
seventeenth vial with pulsatilla. 

Cimicifuga. — This remedy is a valuable one and can 
hardly be dispensed with. It is one of the group of 
remedies in rheumatic conditions applying especially to 
the sexual apparatus of both sexes. Orchialgia, of rheu- 
matic tendency, ovarialgia, and uterine pain, are benefited 
by it. It combines well with pulsatilla in dysmenorrhea. 
In pelvic pain and weight attending gestation it may be 
employed alone or with pulsatilla, to advantage. The 
specific medicine is to be preferred here, though care 
must be exercised about using it in too large doses, as 
the drug is powerful in this form. Half a dram in four 
ounces of water, dose a teaspoonful, is about right. 
The eighteenth remedy will be cimicifuga (macrotys). 

Sabal Serrulata. — Saw palmetto fills a very important 
place ; it will often be serviceable where prostatic pain is 
present. It is the only remedy known which specifically 
relieves painful conditions of the prostatic urethra. The 
analogue of this part, in females, the uterus, also responds 
to its action, and the remedy thus becomes one of frequent 



160 THE MEDICINE CASE. 

demand. Add one or two drams of the fluid extract to 
four ounces of water and order a teaspoonful every two 
or three hours. I usually employ a fluid extract manu- 
factured by Parke, Davis & Co. 

Rhus Aromatica. — We want at least one remedy to 
influence the urinary apparatus, aud this fills the place 
of half-a-dozen ordinary agents. Irritation of the kid- 
neys, and vesical disturbances of acute or subacute char- 
acter are especially relieved by it when properly adapted. 
Vesical tenesmus is an unpleasant symptom often encoun- 
tered, and usually relieved when this remedy is used. 
The specific medicine is most reliable — a dram added 
to four ounces of water ; dose a teaspoonful every two 
or three hours. 

Phenacetin. — This remedy is one which I would not 
like to be without, if I were to practice far from a con- 
venient drug supply. It is the remedy above all others 
for muscular rheumatism and rheumatoid pains gener- 
ally. It is more positive, and fully as "safe as cimicifuga 
or rhus tox., and it acts more promptly in these cases. 
As a remedy for rheumatic seasons, — Winter and Spring, 
it has become almost indispensable to me. Three or 
four grains may be given every three or four hours either 
in acute or chronic cases with full confidence of satis- 
factory results. 

Antifebrin. — This remedy cures headache — migraine— 
in short order. It is applicable to many cases of severe 
spasmodic pain. It is preferable to antipyrin, because 
this is apt to produce debility when frequently repeated. 
Two or three five grain doses half an hour apart will suf- 
fice. It is a remedy for acute troubles and should be 
carried, at least by the country practitioner. 

Quinia Sulphas. — Periodicity will be found in almost 
every location, and cropping out in many a case, to per- 
petuate and aggravate it if not interrupted. Quinia is- 



THE MEDICINE CASE. 161 

the typical antiperiodic. It does not compare with al- 
8tonia as a curer of malarial cachexia, but to interrupt 
periodicity it has no equal, and the medicine case would 
not be complete without it. It might be carried in three- 
grain capsules, thus being covered from the palate so 
that the objectionable taste would be avoided. 

Morphia Sulphas. — The customary vial of morphia can- 
not safely be dispensed with yet. If we cannot cure the 
pain in our patient we must paralyze him, for a time* 
and morphia is the agent to do it with, since it is more 
prompt and reliable while less bulky than other narcotics. 
Pellets of one-fourth grain of the sulphate will serve the 
purpose of combining dose with pleasant form for ad- 
ministration. 

We now have twenty-four remedies selected, and if we 
were perfectly certain that all the agents urgently re- 
quired had been chosen, a twenty-four-vial case might 
answer the purpose. But this number does not make up 
well into a case of vials, each containing enough to sup- 
ply the average country practitioner with a satisfactory 
amount to avoid frequent refilling. A vial once emptied 
is liable to be neglected until the agent is needed again, 
and the vial oftenest emptied is most likely to contain 
the most important remedy. However, twenty-four two, 
or three-dram, slim vials, arranged in two rows, may con- 
stitute a shapely and convenient pocket-case for one who 
needs to resort to it but seldom, but half-ounce vials are 
really small enough for a country outfit. Twelve of these 
would lengthen the case beyond proper proportions, and 
eight would leave the rows rather short, so we will select 
a thirty-vial case, each of the vials to contain half an 
ounce or more, the whole arranged in three rows. Thus 
we have six vials not yet filled, but subject to demand, 
for agents which may prove as important as any of those 
already mentioned, and likely to soon come into service. 
11 



162 THE MEDICINE CASE. 

i 

This case should not take the place of an obstetric 
outfit, which should be at hand, ready, whenever needed, 
in separate bag, with vial of pusatilla, ergot, chloroform, 
etc. An emergency case might also be kept in readiness, 
containing antidotes for poisons, bandages, etc., for acci- 
dents, but the physician would not be benefited by lug- 
ging such an outfit with him day after day. 

BJsumt'.— And now it should not be supposed that an 
effort has been made to designate all the properties of 
agents which have been suggested. Many important 
uses for the different remedies have been passed in 
silence, as this article has not been intended as a treatise 
on materia medica, and the agents have been named 
only in connection with the properties which have the 
most readily suggested them. Many valuable uses may 
be made of various ones in chronic as well as in acute 
diseases, and valuable properties in acute conditions 
have been neglected, as, for instance : — 

Aconite is an almost infallible remedy in non-mem- 
braneous forms of croup — all the remedy we need ; 
jaborandi breaks up a cold very readily in full dose by 
inducing profuse prespiration, and is the best of reme- 
dies where suppression of urine threatens uremia ; rhus 
tox. is our best agent in erysipelas, especially if the tis- 
sues of the face are the parts principally involved, and 
is a superior remedy in ophthalmic practice where the 
appendages of the eye are invaded by inflammatory 
conditions. Sharp pain in the frontal region, especially 
in the left orbit, calls for it, according to Scudder, 
though this I have never been able to prove. 

And so I might go over the list and find new uses for 
nearly every agent mentioned, but instead will respect- 
fully refer the student to my forthcoming work on Spe- 
cific Therapeutics, 



IBDEX. 



Aconite in Croup *. 162 

Aconite in the Medicine Case, its Place 149 

Aconite, Pulse Indications 62 

Alimentary Canal 67 

Antiperiodic, Quinia 160 

Arterial Tension 58 

Art and Science of Prescribing 119 

Asclepias in Pneumonia 154 

Asthma, Tartar Emetic 155 

Auditory Center, Therapeutic Affinities 87 

Aural Pain 116 



Baptisia, Tongue Indications 76 

Belladonna, Pulse Indications 62 

Biliary Ducts, Inflammation of, Chelidonium 157 

Blood Making 39 

Blood Pabulum, How Supplied 40 

Blood Pressure 58 

Bronchochele, Phytolacca 156 

Bronchial Remedies. 155 

Bryonia in Painful Mammae 101 

Capsules as Vehicles 132 

Cardiac Pain, Remedies for 116 

Carduus Marianus in Fullness of the Abdominal ..Vessels 55 

Care of the Medicine Case 148 

Castor Oil, Affinity (for the Mammary Gland 101 

Cereus Bonplandii in Feeble Heart Action 154 

Ceanothus Americanus 55 

Cerebral Pain 116 

Cimicifuga in Rheumatism 159 

Classification of Remedies on the Ground of Dose 18 

Climatic Influence in Insanity 60 

Climate as a Modifier of Arterial Tension 60 

Chelidonium in Hepatic Affections 157 

Cholera Morbus, Rhus Tox. in 152 

Common Examples of Drug Affinity 8 



164 iMJEJL 

Coughing, Center for 89 

Crises in Disease 101 

Cerebro-Spinal Meningitis, Jaborandi in 101 

Clinical Experience Essential to Proper Adaptation of Rem- 
edies to Different Phases of Disease 10 



Defecation, Center of. 93 

Delirium With Restlessness, Rhus Tox 152 

Deglutition, Center for 89 

Depressor Nerve 90 

Dilatation of Pupil, Center for 89 

Dilutions 131 

Dose, Question of. 132 

Dry Tongue 74 

Dry Skin, an Indication for jaborandi 151 



Electricity, its Place as a Remedial Agent 14 

Enteric Pain 116 

Erection of Penis, Center for 94 

Erysipelas, Jaborandi in 151 

Essential Elements to Proper Application of Dynamical 

Therapeutics „ 14 

Excited Circulation, Treatment 47 



Feeble Circulation 48 

Forms for Administration ot Drugs 128 



Gangrene, Arrest of Blood Supply a Cause of. 102 

Gastric Irritibility, Rhus Tox 152 

Gastric Pain, Remedies for 157 

Gelseminum, Specific Indications for 62, 150 

Germicides 25 

Glycerine as a Preservative of Medicines 125 

Glycogenic Function of the Li^r 55 



Hahnneman s Method of Preparing Triturations 127 

Headache, Antifebrin 160 

Heart Diseases, Pulsatilla in 154 

Hemorrhoidal Conditions, Collinsonia in rs8 

Hepatic Pain, Remedies for 117 

Hepatic Colic, Chelidonium r57 



INDEX. 165 

Hydrastis in Myalgia « 117 

Hydrochloric Acid, Tongue Indications for - 76 

Hypogastric Pain 158 

Inflammatory Rheumatism, Jaborandi in 151 

Infusions and Decoctions 146 

Ipecac in the Medicine Case, Cholera Infantum, Bronchitis, etc. 154 

Jaborandi, Indications for 62, 150 

Jaborandi in Meningitis Si 

Jaborandi in Muscular Pain 117 

Jaborandi, its Place in the Medicine Case 150 

Line of Demarkation between Functional and Structural Dis- 
ease, Difficult to Always Determine 24 

Liver, Influence of upon Proteids 56 

Li\ er, Invigorated by Minute Doses of Mercurius Dulcis 57 

Liver, Therapeutics of. 54, 157 

Mammary Gland, Therapeutics of. 100 

Medicine Case 148 

Micturition, Center for 94 

Minuteness of Dose an Essential Element of Success 20 

Modifying Influences in Drug Affinity 15 

Morphological Elements of Disease Considered 14 

Motor Areas 86 

Mucous Membranes, Affinities ^for 100 

Muscular Pain 117 

Myalgia 116 

Neuralgia of the Abdominal Viscera 157 

Neuralgic Pains 117 

New Formations 112 

Nitrate of Uranium in Diabetes. 56 

Nitroglycerine, Pulse Indications for 63 

Nutrition Centers of. 94 

m 

Occipital Pain '17 

Odontalgia 117 

Olfactory Center 86 

Optic Centers 87 

Orchialgia 117 



166 INDEX. 

Orchitis 159 

Origin of Blood Corpuscles 41 



Pain, Definition of, Remedies for 115, 116, 117, 118 

Pancreas, Therapeutics of. 100 

Parenchyma of the Lungs, Agents for 154 

Parturition, Center for 94 

Pathological Processes not Subject to the Same Laws of Con- 
stancy as those of Normal Life 35 

Pelvic Pain During Pregnancy, Pulsatilla for 159 

Penthorum in Chronic Pharyngitis in 

Pericranial Pain ti8 

Periosteal Pain 118 

Pharmaceutical Incom patibility 138 

Pharyngitis, Phytolacca in 156 

Phenacetin in Rheumatism 160 

Physiology teaches the Selective Properties of Cells 8 

Phytolacca in the Medicine Case 156 

Plasma Remedies 21 

Plastic Remedies 22 

Pneumonia, Asclepias in. 154 

Polymnia in Fullness of the Abdominal Capillaries 55 

Potassium Phos., Tongue Indications for 76 

Portal Circulation, 53, Therapeutics of. 54 

Potomaines 21 

Prescribing, Science and Art of 19 

Prescription Writing 140 

Pulmonary Circulation 48 

Pulsatilla in Cardiac Affections 154 

Pulsatilla in Nervousness of Women 159 

Pulse Indications 62 



Quality |of Drugs 119 

Quebracho in Deficient Cardiac and Respiratory Action 153 

Question of Dose i$« 

Reciprocity of Action Between Remedy and Function 35 

Reflexes 16 

Relation of Cardiac and Pulmonary Remedies 51 

Relation of Pathology to Dynamical Therapeutics 31 

Relation of Physiology to Dynamical Therapeutics 35 

Relation of Rectal Diseases to Disordered States of the Ali- 
mentary Canal 69 



INDEX. 16' 

Remedies Which Influence the Blood-Making Processes 43 

Remedies Which Influence the General Circulation 47 

Respiratory Center 89 

Rheumatism, Cimicimga, Phenacetin 159. 160 

Rhus Tox., Tongue Indications for 76 



Saliva, Center for Secretion of 89 

.Salivary Glands, Therapeutics of. 100 

Saw Palmetto, Influence upon the Mammary Gland. 101 

Secretion and Excretion 96 

Selective Properties Common to the Tissues of all Living 

Bodies 7 

Seminal Emission, Center for 94 

Silica in Enchondromata 112 

Sneezing, Center for 89 

Sodium. Sulphite of, its use in Everyday Practice 153 

Special Sedatives 47 

Special Vascular Areas. Therapeutics of. 104 

Special Sedatives Promoters of Secretion 98 

Substitute for Sugar of Milk as a Vehicle in Triturations...... 130 

Sulphite of Sodium, Tongue Indications for -3 

Sulphurous Acid, Tongue Indications for, 76 

Sympathetic Nervous System 95 

Syzygium in Diabetes 56 



The Alimentary Canal 67 

The Blood 38 

The Bronchial Vascular Area Demands a Special Class of 

Remedies 1 54 

The Cerebellum 88 

The Cerebrum 5^ 

The Dual Action of Drugs 18 

The General Circulation 44 

The Medulla Oblongata 88 

The Nervous System 79 

The New Formations 112 

The Old Classification 27 

The Principles of Selection 26 

The Quality of Drugs 119 

The Question of Dose 132 

The Single Remedy Versus Combinations 135 

The Spinal Cord 93 

The Temperature 64 

Therapeutic Classification 17 

Therapeutic Incompatibi lit}- , 1 37 



L68 INDEX. 

Thuja a Remedy for Warts n3 

Times for Gathering Medicinal Plants 122 

Time for Administration of Remedies 139 

Tissue Regeneration 101 

Tongue Indications 75 

Triturations ; 125 

Typhoid Tendency, Rhus Tox. in 152 



Uterine and Ovarian Remedy 57 

Variety of Action of Remedies Upon a Given Part 23 

Vaso-Motor Center 90 

Veratrum, Pulse Indications for 62 

Veratrum, its Place in the Medicine Case 152 

Vesical Irritation, Rhus Aromatica 160 

Vomiting, Center for 89 

Warts, Thuja and Magnesium Sulphate in 113 



SWP 



